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General NPI Number Information
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NPI Number | 1578360517
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Entity Type | Organization
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Legal Business Name | UNIV OF MARYLAND OTORHINOLARYNGOLOGY HEAD & NECK SURGERY PA
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 7251 PREINKERT DRIVE 0110 LEFRAK HALL
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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 | 301-405-4218
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Fax | 301-314-2023
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Provider Business Mailing Address
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Address Line | PO BOX 64693
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City | BALTIMORE
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State | MD
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Zip | 21264-4693
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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
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Name | SHAVONDA L WILLIAMS
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Credential |
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Telephone | 667-214-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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