Provider Demographics
NPI:1407177447
Name:UNIVERSITY OF MARYLAND MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND MEDICAL CENTER, LLC
Other - Org Name:UMMC METHADONE TREATMENT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-1501
Mailing Address - Street 1:PO BOX 62498
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2498
Mailing Address - Country:US
Mailing Address - Phone:717-428-0552
Mailing Address - Fax:
Practice Address - Street 1:1001 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2679
Practice Address - Country:US
Practice Address - Phone:717-428-0552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100083101YA0400X
261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422022600Medicaid