MEDICARE: UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL GROUP, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1881428746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL GROUP, LLC

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	:	443-462-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	14237 JARRETTSVILLE PIKE
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-1403
Country	:	US
Telephone Number	:	410-650-4735
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	THOMAS SMYTH
Credential	:
Telephone Number	:	410-328-1376

Provider Enumeration Date	:	08/31/2024
Last Update Date	:	08/31/2024

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