Provider Demographics
NPI:1720163876
Name:OBSTETRICAL AND GYNECOLOGICAL ASSOC OF THE UNIVERSITY OF MARYLAND PA
Entity Type:Organization
Organization Name:OBSTETRICAL AND GYNECOLOGICAL ASSOC OF THE UNIVERSITY OF MARYLAND PA
Other - Org Name:ACADEMIC DEPT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR PRFOESSIONAL FEES
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BRINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-0353
Mailing Address - Street 1:110 SOUTH PACA ST
Mailing Address - Street 2:SUITE 6N300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1751
Mailing Address - Country:US
Mailing Address - Phone:410-328-0253
Mailing Address - Fax:410-328-3379
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1751
Practice Address - Country:US
Practice Address - Phone:410-320-6640
Practice Address - Fax:410-328-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAFP 723291U00000X
MD723291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAFP 723OtherLAB NUMBER