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BLACKWATER MEDICAL ASSOCIATES, LLC
NPI 1063722171
Specialist in Cambridge, MD

Active since October 08, 2010
408 BYRN ST, CAMBRIDGE, MD 21613(410) 228-1068(410) 228-6338 Get Directions Write a Review

NPPES record last updated: October 8, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Blackwater Medical Associates, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLACKWATER MEDICAL ASSOCIATES, LLC (NPI 1063722171) is a healthcare organization registered as a specialist in Cambridge, Maryland and active in the NPI registry since October 2010. The organization lists Mark Malkus, President, as its authorized official.

NPPES Registry Identity

NPI1063722171
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameBLACKWATER MEDICAL ASSOCIATES, LLC
Location Address408 BYRN STCambridge, MD 21613-1910
Mailing Address408 Byrn StCambridge, MD 21613-1910 · (410) 228-1068 · Fax (410) 228-6338
Phone(410) 228-1068
Fax(410) 228-6338
Organization SubpartNo
Authorized OfficialMark MalkusPresident · (410) 228-1068
Enumeration DateOctober 8, 2010
✔ NPI 1063722171 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MD · D0080504
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
408 BYRN ST, Cambridge, MD 21613
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Other Identifiers 2

Medicare UPING28888MD
Medicaid781000800MD

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARK MUMFORD MALKUS M.D.
Family Medicine
408 BYRN ST
CAMBRIDGE, MD 21613
Dorchester County (410) 228-1068
BLACKWATER MEDICAL ASSOCIATES, LLC
Family Medicine
408 BYRN ST
CAMBRIDGE, MD 21613
Dorchester County (410) 228-1068

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blackwater Medical Associates, LLC's NPI number?

The NPI number for Blackwater Medical Associates, LLC is 1063722171. It was assigned to this organization in the NPPES registry on October 8, 2010.

Where is Blackwater Medical Associates, LLC located?

Blackwater Medical Associates, LLC is located at 408 Byrn St, Cambridge, MD 21613. The listed phone number is (410) 228-1068.

What is Blackwater Medical Associates, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Blackwater Medical Associates, LLC was last updated on October 8, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.