Provider Demographics
NPI:1164765095
Name:UNION MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:UNION MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/PAYOR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NICKEYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-933-3033
Mailing Address - Street 1:201 E UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2829
Mailing Address - Country:US
Mailing Address - Phone:410-554-2000
Mailing Address - Fax:
Practice Address - Street 1:1407 YORK RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6097
Practice Address - Country:US
Practice Address - Phone:410-821-8894
Practice Address - Fax:410-821-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty