Provider Demographics
NPI:1265027072
Name:UROLOGIC PHYSICIAN SERVICES, PC
Entity Type:Organization
Organization Name:UROLOGIC PHYSICIAN SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-504-4004
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-3023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1607 ANNESLEY CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-6497
Practice Address - Country:US
Practice Address - Phone:202-963-1844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty