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General NPI Number Information
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NPI Number | 1477530624
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 821 N EUTAW ST
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City | BALTIMORE
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State | MD
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Zip | 21201-4648
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Country | US
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Telephone | 443-552-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 900 ELKRIDGE LANDING RD FL 2
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City | LINTHICUM
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State | MD
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Zip | 21090-2924
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Country | US
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Telephone | 443-462-5245
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT - CHIEF FINAN
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Name | PAUL STEPHEN NICHOLSON
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Credential | CPA
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Telephone | 410-822-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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