Provider Demographics
NPI:1174669816
Name:UNIVERSITY OF MD DIALYSIS
Entity Type:Organization
Organization Name:UNIVERSITY OF MD DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDNET & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-3276
Mailing Address - Street 1:1301 YORK ROAD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-821-4162
Mailing Address - Fax:410-821-4189
Practice Address - Street 1:22 S GREENE STREET
Practice Address - Street 2:3RD FLOOR ROOM N3E12
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-8667
Practice Address - Fax:410-821-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30068261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD218212OtherALLIANCE PPO
MD57710801OtherBC MAGELLAN
MD57710801OtherBC OF MARYLAND
MD57710801OtherBC NASCO
MDMC6OtherBC FEDERAL PROGRAM
MDMC6OtherBLUE CHOICE BLUE PREFERRE
MD57710801OtherBC OUT OF STATE
MDMC6OtherBCBS CAPITAL CARE
MD=========OtherAPS HEALTHCARE
MD=========OtherAUTO ACCIDENT
MD218212OtherALLIANCE PPO
MD=========OtherELECTRICAL WORKERS
MD57710801OtherBC OUT OF STATE
MD=========OtherEHP
MDMC6OtherBC FEDERAL PROGRAM
MD57710801OtherBC OF MARYLAND
MD57710801OtherBC NASCO
MD=========OtherAMALGAMATED
MD=========OtherCORESOURCE