NPIMap

Organization Active NPI

Maryland Institute for Pelvic Neuro Science LLC

  • Urology Physician
  • Lutherville, MD
National Provider Identifier
1235587874
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
MARYLAND INSTITUTE FOR PELVIC NEURO SCIENCE LLC
Practice address
1447 York Road
Suite 406
Lutherville, MD 21093-6017
Phone
(410) 343-3001
Fax
(410) 823-0015
NPI assigned
May 24, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David A Gordon, MDNPI 1407819642
Title
President
Phone
(410) 343-3001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X Primary
Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2088F0040X

Addresses

Primary practice location

1447 York Road
Suite 406
Lutherville, MD 21093-6017

Mailing address

1447 York Road
Suite 406
Lutherville, MD 21093
Phone (410) 343-3002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231031000700 MD Part B Supplier - Clinic/Group Practice 5294181061 Receives reassigned benefits from 3 practitioners
Practice locations: Lutherville, MD
O20250508000020 DC Part B Supplier - Clinic/Group Practice 5294181061 Receives reassigned benefits from 3 practitioners
Practice locations: Hyattsville, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1235587874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1447 YORK ROAD",
            "address_2": "SUITE 406",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "21093",
            "telephone_number": "410-343-3002",
            "fax_number": "410-823-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1447 YORK ROAD",
            "address_2": "SUITE 406",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210936017",
            "telephone_number": "410-343-3001",
            "fax_number": "410-823-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND INSTITUTE FOR PELVIC NEURO SCIENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-24",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-343-3001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutherville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.