Organization
UROLOGIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARA R HOLTON MD (CEO)
(410) 504-4004
Entity
Organization
Contact information
Practice address
1607 ANNESLEY CT, ANNAPOLIS, MD 21401-6497
(410) 504-4004
Mailing address
PO BOX 1023, GAMBRILLS, MD 21054-3023
(410) 504-4004
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265501746
—
MD
Enumeration date
01/19/2021
Last updated
01/19/2021
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