Provider Demographics
NPI:1679383657
Name:UNIVERSITY OF MARYLAND ORTHOPAEDIC TRAUMA ASSOCIATES, PA
Entity type:Organization
Organization Name:UNIVERSITY OF MARYLAND ORTHOPAEDIC TRAUMA ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-214-2732
Mailing Address - Street 1:2200 KERNAN DR STE 1154
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6665
Mailing Address - Country:US
Mailing Address - Phone:667-214-2732
Mailing Address - Fax:410-448-6296
Practice Address - Street 1:7140 CONTEE RD STE 3000
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9532
Practice Address - Country:US
Practice Address - Phone:410-448-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MARYLAND ORTHOPAEDIC TRAUMA ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty