Provider Demographics
NPI:1386016319
Name:UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, LLC
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND MEDICAL REGIONAL SUPPLIER SERVICES, LLC
Other - Org Name:UNIVERSITY OF MARYLAND MEDICAL SOLUTIONS HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-462-3508
Mailing Address - Street 1:PO BOX 417786
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7786
Mailing Address - Country:US
Mailing Address - Phone:443-462-5850
Mailing Address - Fax:410-636-0309
Practice Address - Street 1:825 N HAMMONDS FERRY RD STE C
Practice Address - Street 2:
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090-1355
Practice Address - Country:US
Practice Address - Phone:443-462-5850
Practice Address - Fax:410-636-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDPW04843336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158154OtherPK