MEDICARE: UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES, PA

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	2086S0120X	Pediatric Surgery Physician

General Provider Information

NPI Number	:	1538097902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	PO BOX 64226
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4226
Country	:	US
Telephone Number	:	667-214-1734
Fax Number	:	410-706-6976

Provider Business Practice Location Address
First Line	:	12203 TULLAMORE RD
Second Line	:
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-7816
Country	:	US
Telephone Number	:	667-214-1718
Fax Number	:	410-328-5147

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	VANENIA CROWDER
Credential	:
Telephone Number	:	667-214-1734

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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