Provider Demographics
NPI:1043684129
Name:UNIVERSITY OF MARYLAND MEDICINE ASC, LLC
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND MEDICINE ASC, LLC
Other - Org Name:UNIVERSITY OF MARYLAND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ASC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-214-2112
Mailing Address - Street 1:250 W PRATT ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5900 WATERLOO RD
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2630
Practice Address - Country:US
Practice Address - Phone:667-214-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical