Provider Demographics
NPI:1245609494
Name:UNIVERSITY OF MARYLAND ATHLETICS-COLLEGE PARK
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND ATHLETICS-COLLEGE PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPORTS MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDWALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-314-2663
Mailing Address - Street 1:379 FIELD HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742-0001
Mailing Address - Country:US
Mailing Address - Phone:301-314-2663
Mailing Address - Fax:301-314-6549
Practice Address - Street 1:379 FIELD HOUSE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-0001
Practice Address - Country:US
Practice Address - Phone:301-314-2663
Practice Address - Fax:301-314-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050588207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty