NPIMap

Organization Active NPI

University of Maryland Sports Medicine and Wellness, LLC

  • Sports Medicine (Family Medicine) Physician
  • Columbia, MD
National Provider Identifier
1750199097
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
UNIVERSITY OF MARYLAND SPORTS MEDICINE AND WELLNESS, LLC
Practice address
5900 Waterloo Rd
Columbia, MD 21045-2639
Phone
(667) 214-1333
NPI assigned
Dec 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Authorized official

Name
Shavonda L Williams
Title
Corporate Director
Phone
(667) 214-2507

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X Primary

Addresses

Primary practice location

5900 Waterloo Rd
Columbia, MD 21045-2639

Mailing address

PO Box 64380
Baltimore, MD 21264-4380

National Provider Directory

National Provider Directory
Tax ID family
University of Maryland Sports Medicine and Wellness LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1734566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1750199097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64380",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 WATERLOO RD",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452639",
            "telephone_number": "667-214-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF MARYLAND SPORTS MEDICINE AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-19",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SHAVONDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CORPORATE DIRECTOR",
        "authorized_official_telephone_number": "667-214-2507"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.