Basic Information
| Provider Information | |||||||||
| NPI: | 1356571939 | ||||||||
| 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: | 3333 N CALVERT ST | ||||||||
| Address2: | JPB, SUITE 107 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212182867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105546505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2009 | ||||||||
| LastUpdateDate: | 08/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
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| AuthorizedOfficialTitleorPosition: | V. P. OF MEDICAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 4105542000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1086 | 01 | MD | CAREFIRST BC/BS DC | OTHER | 433AUN | 01 | MD | CAREFIRST BC/BS MD | OTHER |