=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932936192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED UROLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2024
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 E 9TH AVE STE 470
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80220-3923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-532-8007
-----------------------------------------------------
Fax | 303-625-9719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10200 GRAND CENTRAL AVE STE 220
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-4366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-471-5783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | MADISON WREN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-847-1343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------