Provider Demographics
NPI:1538286174
Name:STATE OF MARLYAND
Entity Type:Organization
Organization Name:STATE OF MARLYAND
Other - Org Name:UMBC UNIVERSITY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH CENTER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:410-455-3751
Mailing Address - Street 1:1000 HILLTOP CIR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21250-0001
Mailing Address - Country:US
Mailing Address - Phone:410-455-2543
Mailing Address - Fax:410-455-1125
Practice Address - Street 1:1000 HILLTOP CIR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21250-0001
Practice Address - Country:US
Practice Address - Phone:410-455-2543
Practice Address - Fax:410-455-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1083837OtherAETNA HMO PROVIDER
MD7719711OtherAETNA INDEMNITY PROVIDER
MD54256405OtherBCBS RENDERING PROVIDER
MD9571898OtherCIGNA PROVIDER NUMBER