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General NPI Number Information
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NPI Number | 1790501971
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF MARYLAND PEDIATRIC ASSOCIATES, PA
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 5 GARRETT AVE
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City | LA PLATA
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State | MD
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Zip | 20646-5960
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Country | US
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Telephone | 301-609-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62063
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City | BALTIMORE
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State | MD
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Zip | 21264-2063
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Country | US
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Telephone | 410-706-5181
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Fax | 410-706-5103
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Authorized Official
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Title or Position | DIRECTOR OF PROFESSIONAL FEES
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Name | MARGIE OLLER BURR
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Credential |
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Telephone | 410-706-5181
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 281PC2000X
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Taxonomy Name | Children's Chronic Disease Hospital
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License Number |
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License Number State |
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