Basic Information
| Provider Information | |||||||||
| NPI: | 1174547525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNION MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 E UNIVERSITY PKWY | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212182829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105542000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1407 YORK ROAD | ||||||||
| Address2: | |||||||||
| City: | LUTHERVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210936077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108218894 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 04/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | V.P. OF MEDICAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 4105542260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 903A | 01 | MD | CAREFIRST BC/BS | OTHER | K587 | 01 | MD | CAREFIRST BC/BS DC | OTHER | 331950403 | 05 | MD | MEDICAID | 891B | 01 | MD | CAREFIRST BC/BS | OTHER | DE3316 | 01 | MD | RAILROAD MEDICARE | OTHER | J848 | 01 | MD | CAREFIRST BC/BS DC | OTHER |