Organization Name: | UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL GROUP, LLC |
NPI Number: | 1770836785 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | S.K.MICHELLE LEE (VP OF FINANCIAL REPORTING) |
Mailing Address: | 7601 Osler Dr Towson |
State: | MD US |
Postal Code: | 212047700 |
Phone Number: | 4103371000 |
Fax Number: | |
NPI Enumeration Date: | 10/16/2012 |
NPI Last Update Date: | 04/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |