Provider Demographics
NPI:1740213453
Name:EMERGENCY PHYSICIAN ASSOCIATES OF MARYLAND, P.C.
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIAN ASSOCIATES OF MARYLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURTAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-848-3721
Mailing Address - Street 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4300
Mailing Address - Fax:856-848-1431
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-532-4040
Practice Address - Fax:410-532-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3509028-00Medicaid
MDLL30/800213-01OtherBCBS (CAREFIRST)
MD3509028-01Medicaid
MDLL30/800213OtherBCBS (CAREFIRST)
MD3509028-01Medicaid
MD=========OtherTRICARE/CHAMPUS
MDLL30/800213OtherBCBS (CAREFIRST)