Provider Demographics
NPI:1104877075
Name:UNIVERSITY OF MARYLAND PHYSICIANS, P.A.
Entity type:Organization
Organization Name:UNIVERSITY OF MARYLAND PHYSICIANS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINGENFELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-328-8040
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8040
Mailing Address - Fax:410-328-0248
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1590
Practice Address - Country:US
Practice Address - Phone:667-214-1515
Practice Address - Fax:410-328-8326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MARYLAND PHYSICIANS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207RG0300X
207RH0002X, 207RH0005X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1104877075Medicaid
DC034460902Medicaid
MD764571600Medicaid
MD764571600Medicaid
MD764571600Medicaid
MDDG4032Medicare PIN
DE1104877075Medicaid
MDCE0025Medicare PIN
DC034460902Medicaid
MDC12585Medicare PIN
MDCG0029Medicare PIN