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General NPI Number Information
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NPI Number | 1164426045
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Entity Type | Organization
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Legal Business Name | ANNE ARUNDEL UROLOGY, PA
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 600 RIDGELY AVE STE 222&223
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1001
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Country | US
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Telephone | 410-266-8049
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Fax | 410-266-8054
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Provider Business Mailing Address
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Address Line | 600 RIDGELY AVE STE 130
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1045
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Country | US
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Telephone | 410-266-8049
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Fax | 410-266-8054
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MARA HOLTON
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Credential | MD
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Telephone | 410-504-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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