Provider Demographics
NPI:1497053045
Name:ADVANCED UROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-751-2363
Mailing Address - Street 1:193 STONER AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5587
Mailing Address - Country:US
Mailing Address - Phone:410-751-2363
Mailing Address - Fax:410-751-2338
Practice Address - Street 1:193 STONER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5587
Practice Address - Country:US
Practice Address - Phone:410-751-2363
Practice Address - Fax:410-751-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD786602000Medicaid
MD786602000Medicaid