University Of Maryland Community Medical Group, INC.
Family Medicine in La Plata, MD. Organization (NPI-2).
NPI number1053166314
StatusActive
Last updated in NPPESApr 20, 2024
Details
- NPI
- 1053166314
- Entity type
- Organization (NPI-2)
- Legal business name
- University Of Maryland Community Medical Group, INC.
- Organization subpart
- No
- Enumeration date
- Apr 20, 2024
- Certification date
- Apr 20, 2024
- Last updated
- Apr 20, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
616 East Charles StreetSuite 102
La Plata, MD 20646-5938
Phone 301-609-5445
Mailing address
900 Elkridge Landing Rd Fl 2Linthicum, MD 21090-2924
Authorized official
Paul Stephen Nicholson
Ao
4103371602
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