Provider Demographics
NPI:1144252990
Name:UNIVERSITY OF MD OBSTETRICAL AND GYNECOLOGICAL ASSO. PA
Entity type:Organization
Organization Name:UNIVERSITY OF MD OBSTETRICAL AND GYNECOLOGICAL ASSO. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HYNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-214-1314
Mailing Address - Street 1:PO BOX 64551
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4551
Mailing Address - Country:US
Mailing Address - Phone:667-214-1301
Mailing Address - Fax:410-328-3379
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:667-214-1300
Practice Address - Fax:410-328-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH590OtherMEDICARE PTAN
MD969081600Medicaid
MDCI3558Medicare PIN
MDH590OtherMEDICARE PTAN