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General NPI Number Information
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NPI Number | 1245609494
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF MARYLAND ATHLETICS-COLLEGE PARK
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 379 FIELD HOUSE DR
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City | COLLEGE PARK
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State | MD
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Zip | 20742-0001
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Country | US
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Telephone | 301-314-2663
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Fax | 301-314-6549
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Provider Business Mailing Address
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Address Line | 379 FIELD HOUSE DR
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City | COLLEGE PARK
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State | MD
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Zip | 20742-0001
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Country | US
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Telephone | 301-314-2663
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Fax | 301-314-6549
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Authorized Official
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Title or Position | DIRECTOR OF SPORTS MEDICINE
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Name | MR. STEVE NORDWALL
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Credential |
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Telephone | 301-314-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | D0050588
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License Number State | MD
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