University Of Maryland Community Medical Group, INC.
Family Medicine in La Plata, MD. Organization (NPI-2).
NPI number1609693118
StatusActive
Last updated in NPPESSep 25, 2024
Details
- NPI
- 1609693118
- Entity type
- Organization (NPI-2)
- Legal business name
- University Of Maryland Community Medical Group, INC.
- Organization subpart
- No
- Enumeration date
- Sep 25, 2024
- Certification date
- Sep 25, 2024
- Last updated
- Sep 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
| 208000000X | Pediatrics | – | – |
Practice location
101 Centennial St Ste ELa Plata, MD 20646-5976
Phone 301-392-0525
Mailing address
900 Elkridge Landing Rd Fl 2Linthicum, MD 21090-2924
Phone 443-462-5010
Authorized official
Paul Stephen Nicholson
Senior Vice President
4103371602
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