Provider Demographics
NPI:1487286050
Name:UM FDSP ASSOCIATES, P.A.
Entity type:Organization
Organization Name:UM FDSP ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF MEDICAL CREDENTIALING & QA
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARKWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-706-5806
Mailing Address - Street 1:650 W BALTIMORE ST RM 5201
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1510
Mailing Address - Country:US
Mailing Address - Phone:410-706-5806
Mailing Address - Fax:410-706-3028
Practice Address - Street 1:9631 GUDELSKY DRIVE
Practice Address - Street 2:SUITE 2135
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:240-665-6700
Practice Address - Fax:410-706-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty