Organization
ADULT & PEDIATRIC UROLOGY GROUP OF MARYLAND LLC
Active
Organization
ADULT & PEDIATRIC UROLOGY GROUP OF MARYLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGET MASTROUNNI (PRACTICE ADMINISTRATOR)
(410) 646-0331
Entity
Organization
Contact information
Practice address
3455 WILKENS AVE, SUITE 100, BALTIMORE, MD 21229-5213
(410) 646-0330
(410) 644-6182
Mailing address
3455 WILKENS AVE, SUITE 100, BALTIMORE, MD 21229-5213
(410) 646-0330
(410) 644-6182
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033000100
—
MD
01
—
1507AD
CAREFIRST BCBS OF MD ID
MD
01
—
E612
CAREFIRST FEDERAL ID
MD
Enumeration date
02/02/2007
Last updated
01/14/2013
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