MEDICARE: UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, 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	333600000X	Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy	PW0484	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2158154	OTHER		PK

General Provider Information

NPI Number	:	1386016319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, LLC

Provider Business Mailing Address
First Line	:	825 N HAMMONDS FERRY RD STE C
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-1355
Country	:	US
Telephone Number	:	443-462-5850
Fax Number	:	410-636-0309

Provider Business Practice Location Address
First Line	:	825 N HAMMONDS FERRY RD STE C
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-1355
Country	:	US
Telephone Number	:	443-462-5850
Fax Number	:	410-636-0309

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	JON BURNS
Credential	:
Telephone Number	:	443-462-3508

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	03/10/2025

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