Provider Demographics
NPI:1740455039
Name:MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C.
Entity type:Organization
Organization Name:MARYLAND CENTER FOR NEURO-OPHTHALMOLOGY & NEURO-OTOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-740-1000
Mailing Address - Street 1:10724 LITTLE PATUXENT PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3253
Mailing Address - Country:US
Mailing Address - Phone:410-740-1000
Mailing Address - Fax:410-740-1003
Practice Address - Street 1:10724 LITTLE PATUXENT PKWY STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3253
Practice Address - Country:US
Practice Address - Phone:410-740-1000
Practice Address - Fax:410-740-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD466332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150602100Medicaid
MD150602100Medicaid