Provider Demographics
NPI:1437102035
Name:CENTRAL MARYLAND UROLOGY ASSOCIATES P A
Entity Type:Organization
Organization Name:CENTRAL MARYLAND UROLOGY ASSOCIATES P A
Other - Org Name:CENTRAL MARYLAND UROLOGY ASSOCIATES, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:B
Authorized Official - Last Name:APPLESTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-772-7000
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:130
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-772-7000
Mailing Address - Fax:410-772-7072
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:130
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-772-7000
Practice Address - Fax:410-772-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032691208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKK88Medicare PIN