Provider Demographics
NPI:1902074404
Name:STATE OF MARYLAND - UNIVERSITY OF MARYLAND COLLEGE PARK
Entity Type:Organization
Organization Name:STATE OF MARYLAND - UNIVERSITY OF MARYLAND COLLEGE PARK
Other - Org Name:UNIVERSITY OF MARYLAND, COLLEGE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-405-5401
Mailing Address - Street 1:110 LEFRAK HALL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742-0001
Mailing Address - Country:US
Mailing Address - Phone:301-405-4218
Mailing Address - Fax:301-314-2023
Practice Address - Street 1:110 LEFRAK HALL
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-0001
Practice Address - Country:US
Practice Address - Phone:301-405-4218
Practice Address - Fax:301-314-2023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MARYLAND - UNIVERSITY OF MARYLAND COLLEGE PARK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00130231H00000X, 237600000X
MD02036235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty