Provider Demographics
NPI:1104832948
Name:UNIV OF MARYLAND OTORHINOLARYNGOLOGY HEAD & NECK SURGERY PA
Entity Type:Organization
Organization Name:UNIV OF MARYLAND OTORHINOLARYNGOLOGY HEAD & NECK SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STROME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-328-6897
Mailing Address - Street 1:PO BOX 64693
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4693
Mailing Address - Country:US
Mailing Address - Phone:410-328-6897
Mailing Address - Fax:410-328-2109
Practice Address - Street 1:16 S EUTAW ST
Practice Address - Street 2:5TH FL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1606
Practice Address - Country:US
Practice Address - Phone:410-328-6897
Practice Address - Fax:410-328-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD925BUNOtherBCBS GROUP NUMBER
MD218NMedicare PIN