Provider Demographics
NPI:1376869255
Name:WASHINGTON UNIVERSITY CLINICAL ASSOCIATES - MARYLAND MEDICAL
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY CLINICAL ASSOCIATES - MARYLAND MEDICAL
Other - Org Name:WUCA-MARYLAND MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-935-0770
Mailing Address - Street 1:1110 HIGHLANDS PLAZA DR E
Mailing Address - Street 2:SUITE 375
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1350
Mailing Address - Country:US
Mailing Address - Phone:314-367-3113
Mailing Address - Fax:314-454-9382
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E
Practice Address - Street 2:SUITE 375
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1350
Practice Address - Country:US
Practice Address - Phone:314-367-3113
Practice Address - Fax:314-454-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty