Provider Demographics
NPI:1083624225
Name:UNIVERSITY OF MARYLAND SURGCIAL ASSOC PA
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND SURGCIAL ASSOC PA
Other - Org Name:UNIVERSITY OF MARYLAND UROLOGICAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-2657
Mailing Address - Street 1:PO BOX 64226
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4226
Mailing Address - Country:US
Mailing Address - Phone:410-328-4080
Mailing Address - Fax:410-328-2109
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 310
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-4080
Practice Address - Fax:410-328-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDHM1171OtherFREESTATE GRP NUMBER
MD101ZUNMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER