Basic Information
| Provider Information | |||||||||
| NPI: | 1982847778 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIV OF MARYLAN OTORHINOLARYNGOLOGY HEAD & NECK SURGERY PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64693 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286897 | ||||||||
| FaxNumber: | 4103282109 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 S EUTAW ST FL 5 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286897 | ||||||||
| FaxNumber: | 4103282109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2009 | ||||||||
| LastUpdateDate: | 04/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | STROME | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4103286897 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 411662300 | 05 | MD | MEDICAID |