Basic Information
| Provider Information | |||||||||
| NPI: | 1174669816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF MD DIALYSIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 YORK ROAD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | LUTHERVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108214162 | ||||||||
| FaxNumber: | 4108214189 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 S GREENE STREET | ||||||||
| Address2: | 3RD FLOOR ROOM N3E12 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103288667 | ||||||||
| FaxNumber: | 4108214189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FRANEY | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDNET & 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 | 261QE0700X | 30068 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 218212 | 01 | MD | ALLIANCE PPO | OTHER | 57710801 | 01 | MD | BC MAGELLAN | OTHER | 57710801 | 01 | MD | BC OF MARYLAND | OTHER | 57710801 | 01 | MD | BC NASCO | OTHER | MC6 | 01 | MD | BC FEDERAL PROGRAM | OTHER | MC6 | 01 | MD | BLUE CHOICE BLUE PREFERRE | OTHER | 57710801 | 01 | MD | BC OUT OF STATE | OTHER | MC6 | 01 | MD | BCBS CAPITAL CARE | OTHER |