Provider Demographics
NPI:1508807355
Name:UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION
Other - Org Name:CRNA/UNIVERSITY OF MARYLAND MEDICAL SYSTEM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL FEES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:OUADDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-6566
Mailing Address - Street 1:PO BOX 64795
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4795
Mailing Address - Country:US
Mailing Address - Phone:410-328-6704
Mailing Address - Fax:410-328-4124
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6704
Practice Address - Fax:410-328-4124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MARYLAND MEDICAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2009-07-07
Deactivation Date:2008-09-05
Deactivation Code:
Reactivation Date:2009-07-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDIN01Medicare ID - Type Unspecified