Provider Demographics
NPI:1811902489
Name:UNIVERSITY OF MARYLAND NEUROLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:UNIVERSITY OF MARYLAND NEUROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-3892
Mailing Address - Street 1:PO BOX 64526
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4526
Mailing Address - Country:US
Mailing Address - Phone:410-328-4323
Mailing Address - Fax:410-328-1149
Practice Address - Street 1:16 S EUTAW ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1606
Practice Address - Country:US
Practice Address - Phone:410-328-4323
Practice Address - Fax:410-328-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS303Medicare PIN