Provider Demographics
NPI:1558394411
Name:UNIVERSITY OF MARYLAND PATHOLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:UNIVERSITY OF MARYLAND PATHOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR, FPI PROFESSIONA
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-302-2229
Mailing Address - Street 1:PO BOX 64592
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4592
Mailing Address - Country:US
Mailing Address - Phone:410-328-5514
Mailing Address - Fax:410-328-0929
Practice Address - Street 1:655 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1509
Practice Address - Country:US
Practice Address - Phone:410-706-3026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD355291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
332RMedicare ID - Type Unspecified