Basic Information
| Provider Information | |||||||||
| NPI: | 1174660120 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11311 MCCORMICK RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210311004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108214140 | ||||||||
| FaxNumber: | 4108214189 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 S GREENE STREET | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103288667 | ||||||||
| FaxNumber: | 4108214189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | FRANEY | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT & CFO | ||||||||
| AuthorizedOfficialTelephone: | 4103283276 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 30068 | MD | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 340925200 | 05 | MD | MEDICAID | 57710801 | 01 | MD | BC MAGELLAN | OTHER | 57710801 | 01 | MD | BC NASCO | OTHER | 57710801 | 01 | MD | BC OF MARYLAND | OTHER | 57710801 | 01 | MD | BC OUT OF STATE | OTHER | MC6 | 01 | MD | BLUE CHOICE BLUE PREFERRE | OTHER | MC6 | 01 | MD | BCBS CAPITAL CARE | OTHER | 218212 | 01 | MD | ALLIANCE PPO | OTHER | MC6 | 01 | MD | BC FEDERAL PROGRAM | OTHER |