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NPI Code Detail

MEDICARE: UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.

MEDICARE: UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1841046539
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 900 ELKRIDGE LANDING RD FL 2
Second Line :
City : LINTHICUM
State : MD
Zip : 21090-2924
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12020 REISTERSTOWN RD
Second Line :
City : REISTERSTOWN
State : MD
Zip : 21136-3041
Country : US
Telephone Number : 410-833-3801
Fax Number :
Authorized Official
Title or Position : AO
Name : PAUL STEPHEN NICHOLSON
Credential :
Telephone Number : 410-337-1602
Provider Enumeration Date : 04/24/2024
Last Update Date : 04/24/2024

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