Provider Demographics
NPI:1659304152
Name:UNIVERSITY OF MARYLAND DERMATOLOGISTS PA
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND DERMATOLOGISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-328-5767
Mailing Address - Street 1:PO BOX 64445
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4445
Mailing Address - Country:US
Mailing Address - Phone:410-328-5767
Mailing Address - Fax:410-328-0098
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 160
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-3167
Practice Address - Fax:410-328-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS045OtherBLUE SHIELD FEDERAL
MDS045OtherBLUE SHIELD FEDERAL
CC2772Medicare PIN