Provider Demographics
NPI:1659664498
Name:UNIVERISTY OF MARYLAND MEDICINE CENTER
Entity Type:Organization
Organization Name:UNIVERISTY OF MARYLAND MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND CHIEF MEDICAL
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTLEIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-328-6858
Mailing Address - Street 1:6515 BLVD EAST APT 6G
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4205
Mailing Address - Country:US
Mailing Address - Phone:917-504-9441
Mailing Address - Fax:
Practice Address - Street 1:29 S GREENE ST # GS100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1504
Practice Address - Country:US
Practice Address - Phone:410-328-6435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069523A282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren