Basic Information
| Provider Information | |||||||||
| NPI: | 1720163876 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OBSTETRICAL AND GYNECOLOGICAL ASSOC OF THE UNIVERSITY OF MARYLAND PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ACADEMIC DEPT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 SOUTH PACA ST | ||||||||
| Address2: | SUITE 6N300 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103280253 | ||||||||
| FaxNumber: | 4103283379 | ||||||||
| Practice Location | |||||||||
| Address1: | 419 W REDWOOD ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103206640 | ||||||||
| FaxNumber: | 4103283379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BRINEGAR | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR PRFOESSIONAL FEES | ||||||||
| AuthorizedOfficialTelephone: | 4103280353 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 723 | MD | N | Laboratories | Clinical Medical Laboratory | 291U00000X | AFP 723 | MD | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | AFP 723 | 01 | MD | LAB NUMBER | OTHER |