MEDICARE: DR. GEORGE J MAMO M.D.

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	208800000X	Urology Physician	D0036523	MD

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
2	52581804	OTHER	MD	CAREFIRST OF MD PROV. NO.
3	1900383	OTHER	MD	AMERICHOICE PROV. NO.
4	E6120002	OTHER	MD	BCBS FEDERAL PROVIDER NO.
5	20679012	OTHER	MD	UNITED HEALTHCARE
6	E6120002	OTHER	MD	BLUE CHOICE PROV. NO.
7	614797	OTHER	MD	MAMSI PROVIDER NUMBER

General Provider Information

NPI Number	:	1588716641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE J MAMO M.D.

Provider Business Mailing Address
First Line	:	10200 GRAND CENTRAL AVE STE 220
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 WILKENS AVE STE 2010
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5072
Country	:	US
Telephone Number	:	410-664-0929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	03/12/2025

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