Provider Demographics
NPI:1386519734
Name:UNIVERSITY OF MARYLAND NEUROSURGERY ASSOCIATES P A
Entity type:Organization
Organization Name:UNIVERSITY OF MARYLAND NEUROSURGERY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT OPS CREDENTIALING SPE
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-214-1353
Mailing Address - Street 1:PO BOX 64315
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4315
Mailing Address - Country:US
Mailing Address - Phone:410-328-8209
Mailing Address - Fax:410-328-1413
Practice Address - Street 1:9300 LOTTSFORD RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4886
Practice Address - Country:US
Practice Address - Phone:410-328-8209
Practice Address - Fax:410-328-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty