MEDICARE: UNIVERSITY OF MARYLAND ST. JOSEPH ORTHOPAEDICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043864002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MARYLAND ST. JOSEPH ORTHOPAEDICS, LLC

Provider Business Mailing Address
First Line	:	8322 BELLONA AVE STE 204
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-2065
Country	:	US
Telephone Number	:	410-337-7900
Fax Number	:	410-769-8591

Provider Business Practice Location Address
First Line	:	9110 PHILADELPHIA RD STE 308
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21237-4327
Country	:	US
Telephone Number	:	410-337-7900
Fax Number	:	410-391-8084

Authorized Official
Title or Position	:	CFO
Name	:	PAUL STEPHEN NICHOLSON
Credential	:
Telephone Number	:	410-337-1602

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	07/29/2019

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