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University of Maryland Community Medical Group, Inc.

Organization Active NPI Family Medicine Physician · Queenstown, MD

NPI 1093561771 · NPPES record last updated Apr 24, 2024

Key facts

NPI
1093561771
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Practice address
125 Shore Way Dr
Suite 240
Queenstown, MD 21658-1682
Phone
(410) 758-8776
NPI assigned
Apr 24, 2024
Organization subpart
No

Authorized official

Name
Paul Stephen Nicholson
Title
Ao
Phone
(410) 337-1602

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2004486University of Maryland Community Medical Group
125 Shore Way Dr Suite 210, Queenstown, MD 21658		Certificate of waiverNov 13, 2027

National Provider Directory

Tax ID family
University of Maryland Community Medical Group Inc (171 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

125 Shore Way Dr
Suite 240
Queenstown, MD 21658-1682

Mailing address

900 Elkridge Landing Rd FL 2
Linthicum, MD 21090-2924

Other providers in Queenstown, MD

All providers in Queenstown, MD · Family Medicine Physician in Maryland

Sources for this page

Verify at the official NPI Registry.