Provider Demographics
NPI:1164426045
Name:ANNE ARUNDEL UROLOGY, PA
Entity Type:Organization
Organization Name:ANNE ARUNDEL UROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-504-4004
Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1045
Mailing Address - Country:US
Mailing Address - Phone:410-266-8049
Mailing Address - Fax:410-266-8054
Practice Address - Street 1:600 RIDGELY AVE STE 222&223
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1001
Practice Address - Country:US
Practice Address - Phone:410-266-8049
Practice Address - Fax:410-266-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD911641901Medicaid
MDH673Medicare ID - Type Unspecified
DCG20609Medicare PIN