Provider Demographics
NPI:1538499165
Name:UNIVERSITY OF MARYLAND MED SYSTEMS CORP - HARAMBEE
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND MED SYSTEMS CORP - HARAMBEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINTRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-5881
Mailing Address - Street 1:PO BOX 62498
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2498
Mailing Address - Country:US
Mailing Address - Phone:410-328-5881
Mailing Address - Fax:
Practice Address - Street 1:630 W FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1543
Practice Address - Country:US
Practice Address - Phone:410-328-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERISTY OF MARYLAND MEDICAL SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101287101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty