Provider Demographics
NPI:1477877215
Name:UNIVERSITY OF MARYLAND
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND
Other - Org Name:UNIVERSITY OF MARYLAND SPORTS MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:ASST. ATHLETIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, EMT-B
Authorized Official - Phone:301-314-2663
Mailing Address - Street 1:379 FIELD HOUSE DR
Mailing Address - Street 2:GOSSETT FOOTBALL TEAM HOUSE
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742-0001
Mailing Address - Country:US
Mailing Address - Phone:301-314-2663
Mailing Address - Fax:301-314-6549
Practice Address - Street 1:379 FIELD HOUSE DR
Practice Address - Street 2:GOSSETT FOOTBALL TEAM HOUSE
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-0001
Practice Address - Country:US
Practice Address - Phone:301-314-2663
Practice Address - Fax:301-314-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health