Provider Demographics
NPI:1225527179
Name:CENTER FOR UROLOGIC SPECIALTIES LLC
Entity Type:Organization
Organization Name:CENTER FOR UROLOGIC SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:REDWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-601-1441
Mailing Address - Street 1:5051 GREENSPRING AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4358
Mailing Address - Country:US
Mailing Address - Phone:410-601-1441
Mailing Address - Fax:410-601-1438
Practice Address - Street 1:5051 GREENSPRING AVE STE 302
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4358
Practice Address - Country:US
Practice Address - Phone:410-601-1441
Practice Address - Fax:410-601-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty