Provider Demographics
NPI:1447419049
Name:UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Other - Org Name:BWMC- TATE CANCER CENTER RAD ONC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-822-1000
Mailing Address - Street 1:305 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5805
Mailing Address - Country:US
Mailing Address - Phone:410-553-8100
Mailing Address - Fax:410-553-8140
Practice Address - Street 1:305 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5805
Practice Address - Country:US
Practice Address - Phone:410-553-8100
Practice Address - Fax:410-553-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDA4373Medicare PIN
MD560MMedicare PIN