Provider Demographics
NPI:1811578800
Name:UNIVERSITY OF MARYLAND ST. JOSEPH REHABILITATION MEDICINE, LLC
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND ST. JOSEPH REHABILITATION MEDICINE, LLC
Other - Org Name:UNIVERSITY OF MARYLAND ST. JOSEPH OUTPATIENT REHABILITATION INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMYTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-337-1602
Mailing Address - Street 1:7601 OSLER DR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7501 OSLER DR STE 301
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7744
Practice Address - Country:US
Practice Address - Phone:410-337-1349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MARYLAND ST. JOSEPH HEALTH SYSTEM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-20
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation