University Of Maryland Community Medical Group, INC.
Family Medicine in La Plata, MD. Organization (NPI-2).
NPI number1891545869
StatusActive
Last updated in NPPESMar 25, 2024
Details
- NPI
- 1891545869
- Entity type
- Organization (NPI-2)
- Legal business name
- University Of Maryland Community Medical Group, INC.
- Organization subpart
- No
- Enumeration date
- Mar 25, 2024
- Certification date
- Mar 24, 2024
- Last updated
- Mar 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
101 Charles StreetSuite 104
La Plata, MD 20646-4901
Phone 301-609-4800
Mailing address
900 Elkridge Landing Rd Fl 2Linthicum, MD 21090-2924
Authorized official
Paul Stephen Nicholson
Ao
4103371602
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