Healthcare Provider Details

I. General information

NPI: 1225383250
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND MEDICAL REGIONAL PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8322 BELLONA AVE SUITE 100
TOWSON MD
21204-2065
US

IV. Provider business mailing address

7601 OSLER DR
TOWSON MD
21204-7700
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-7900
  • Fax: 410-337-5321
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17135
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01908
License Number StateMD

VIII. Authorized Official

Name: PAUL NICHOLSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 410-337-1000