Provider Demographics
NPI:1194831818
Name:UROLOGY ASSOCIATES ASC
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES ASC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-724-0132
Mailing Address - Street 1:902 SETON DRIVE
Mailing Address - Street 2:STE #307
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-724-0132
Mailing Address - Fax:301-759-5874
Practice Address - Street 1:902 SETON DRIVE
Practice Address - Street 2:STE #307
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-724-0132
Practice Address - Fax:301-759-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1262208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001751000Medicaid
MD409255400Medicaid
MD068ZMedicare PIN