Provider Demographics
NPI:1336956812
Name:UNIVERSITY OF MARYLAND FACULTY SPECIALTY CARE NETWORK LLC
Entity type:Organization
Organization Name:UNIVERSITY OF MARYLAND FACULTY SPECIALTY CARE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & SR DIRECTOR OF PAY
Authorized Official - Prefix:
Authorized Official - First Name:KAYVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-214-1086
Mailing Address - Street 1:250 W PRATT ST STE 901
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-6808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 W PRATT ST STE 901
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-6808
Practice Address - Country:US
Practice Address - Phone:667-214-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty