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General NPI Number Information
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NPI Number | 1104623867
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF MARYLAND DERMATOLOGISTS PA
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 1447 YORK RD STE 102
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City | LUTHERVILLE
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State | MD
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Zip | 21093-6017
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Country | US
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Telephone | 667-214-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 250 W PRATT ST STE 900
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City | BALTIMORE
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State | MD
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Zip | 21201-6808
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CORPORATE DIRECTOR PROFESSIONAL FEE
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Name | SHAVONDA L WILLIAMS
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Credential |
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Telephone | 667-214-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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