University of Maryland Community Medical Group, Inc.
Organization Active NPI Family Medicine Physician · La Plata, MD
NPI 1053166314 · NPPES record last updated Apr 20, 2024
Key facts
- NPI
- 1053166314
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
- Practice address
- 616 East Charles Street
Suite 102
La Plata, MD 20646-5938 - Phone
- (301) 609-5445
- NPI assigned
- Apr 20, 2024
- Organization subpart
- No
Authorized official
- Name
- Paul Stephen Nicholson
- Title
- Ao
- Phone
- (410) 337-1602
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2330496 | University of Maryland Community Medical Group | Certificate of waiver | Sep 16, 2027 |
National Provider Directory
- Tax ID family
- University of Maryland Community Medical Group Inc
Locations
616 Charles St
Ste 102
La Plata, MD 20646
Phone (301) 609-4974
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
616 East Charles Street
Suite 102
La Plata, MD 20646-5938
Mailing address
900 Elkridge Landing Rd FL 2
Linthicum, MD 21090-2924
Other providers in La Plata, MD
- Umaru Labay-Kamara, MD, LLC
- Cyprian Ike Ume
- Umms Ambulatory Care LLC
- University of Maryland Charles Regional Urgent Care, LLC
- University of Maryland Community Medical Group, Inc.
- University of Maryland Community Medical Group, Inc.
- University of Maryland Community Medical Group, Inc.
- University of Maryland Community Medical Group, Inc.
- University of Maryland Community Medical Group, Inc.
- University of Maryland Community Medical Group, Inc.
All providers in La Plata, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.