Provider Demographics
NPI:1104909449
Name:U M FDSP ASSOCIATES PA
Entity type:Organization
Organization Name:U M FDSP ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MEILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-706-7628
Mailing Address - Street 1:650 W BALTIMORE ST
Mailing Address - Street 2:ROOM 5201
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1510
Mailing Address - Country:US
Mailing Address - Phone:410-706-7625
Mailing Address - Fax:410-706-3028
Practice Address - Street 1:650 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1510
Practice Address - Country:US
Practice Address - Phone:410-706-7625
Practice Address - Fax:410-706-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406017200Medicaid
MD218445197-0001OtherCAREFIRST BCBS FEDERAL
MD642115-01OtherCAREFIRST BCBS
MD218445197-0001OtherCAREFIRST BCBS FEDERAL
U95340Medicare UPIN
MDKK64J768Medicare ID - Type Unspecified