=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043684129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF MARYLAND MEDICINE ASC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2015
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 WATERLOO RD SUITE 120
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-214-2112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5900 WATERLOO RD STE 120
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-214-2300
-----------------------------------------------------
Fax | 410-799-5206
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ADMINISTRATOR
-----------------------------------------------------
Name | HAE LIN RETZ
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 667-214-2300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------