MEDICARE: ADVANCED UROLOGY, PLLC

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

General Provider Information

NPI Number	:	1932936192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED UROLOGY, PLLC

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	:	443-471-5783
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 E 9TH AVE STE 470
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3923
Country	:	US
Telephone Number	:	303-532-8007
Fax Number	:	303-625-9719

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MADISON WREN
Credential	:
Telephone Number	:	843-847-1343

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	03/20/2025

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