Provider Demographics
NPI:1336311042
Name:UNIVERSITY OF MARYLAND TRAUMA ORTHOPAEDIC
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND TRAUMA ORTHOPAEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEMERE
Authorized Official - Middle Name:
Authorized Official - Last Name:TECLAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:410-328-1640
Mailing Address - Street 1:22 SOUTH GREENE STREET
Mailing Address - Street 2:UMMS
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-1640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPA63866284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital