Provider Demographics
NPI:1790831345
Name:UNITED MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:UNITED MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALINE
Authorized Official - Middle Name:O
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-441-1234
Mailing Address - Street 1:6201 GREENBELT RD
Mailing Address - Street 2:SUITE L5
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2354
Mailing Address - Country:US
Mailing Address - Phone:301-441-1234
Mailing Address - Fax:301-441-1235
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:SUITE L5
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-441-1234
Practice Address - Fax:301-441-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD52430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG92225Medicare UPIN
MDG01791Medicare ID - Type Unspecified