Provider Demographics
NPI:1316021355
Name:U M FDSP ASSOCIATES PA
Entity Type:Organization
Organization Name:U M FDSP ASSOCIATES PA
Other - Org Name:ORAL PATHOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-706-7936
Mailing Address - Street 1:650 W. BALTIMORE ST.
Mailing Address - Street 2:7 NORTH
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1586
Mailing Address - Country:US
Mailing Address - Phone:410-706-7936
Mailing Address - Fax:410-706-6115
Practice Address - Street 1:650 W. BALTIMORE ST.
Practice Address - Street 2:7-NORTH
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1586
Practice Address - Country:US
Practice Address - Phone:410-706-7936
Practice Address - Fax:410-706-6115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U M FDSP ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD46261223S0112X
291U00000X
MD182291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD190003329OtherRAILROAD MEDICARE
MD418538200Medicaid
W692Medicare PIN
MD418538200Medicaid