Provider Demographics
NPI:1548210156
Name:UNIVERSITY OF MARYLAND PHYSICIANS PA
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND PHYSICIANS PA
Other - Org Name:UNIVERSITY OF MARYLAND MEDICAL GROUP - GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL FEES
Authorized Official - Prefix:MS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-8040
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8040
Mailing Address - Fax:410-328-0248
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:410-328-8040
Practice Address - Fax:410-328-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1548210156Medicaid
TN4005765OtherBLUE CROSS/BLUE SHIELD
NJ8183201Medicaid
TN4005765OtherBLUE CROSS/BLUE SHIELD
NJ8183201Medicaid
MDCE0025Medicare PIN
MDCI2585Medicare PIN