Provider Demographics
NPI:1932861762
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:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL FEES
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-214-1301
Mailing Address - Street 1:250 W PRATT ST STE 880
Mailing Address - Street 2:ATTN: RICK BRINEGAR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-6829
Mailing Address - Country:US
Mailing Address - Phone:667-214-1301
Mailing Address - Fax:
Practice Address - Street 1:120 PENN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1082
Practice Address - Country:US
Practice Address - Phone:667-214-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD969081600Medicaid