Provider Demographics
NPI:1760572986
Name:UNIVERSITY OF MARYLAND MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND MEDICAL CENTER
Other - Org Name:UNIVERSITY OF MARYLAND COMMUNITY PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:TOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-7037
Mailing Address - Street 1:PO BOX 64277
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4277
Mailing Address - Country:US
Mailing Address - Phone:410-328-7037
Mailing Address - Fax:410-328-3311
Practice Address - Street 1:630 W FAYETTE ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1543
Practice Address - Country:US
Practice Address - Phone:410-328-2207
Practice Address - Fax:410-328-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD044LMedicare ID - Type Unspecified