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UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
NPI 1093561771
Family Medicine in Queenstown, MD

Active since April 24, 2024CLIA Certified · 2 labs
125 SHORE WAY DR, SUITE 240, QUEENSTOWN, MD 21658(410) 758-8776 Get Directions Write a Review

NPPES record last updated: April 24, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About University Of Maryland Community Medical Group, Inc. NPPES

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

UNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC. (NPI 1093561771) is a healthcare organization registered as a family medicine in Queenstown, Maryland and active in the NPI registry since April 2024. The organization holds 2 active CLIA laboratory certificates and lists Paul Stephen Nicholson, Ao, as its authorized official.

NPPES Registry Identity

NPI1093561771
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameUNIVERSITY OF MARYLAND COMMUNITY MEDICAL GROUP, INC.
Location Address125 SHORE WAY DR, SUITE 240Queenstown, MD 21658-1682
Mailing Address900 Elkridge Landing Rd Fl 2Linthicum, MD 21090-2924
Phone(410) 758-8776
Organization SubpartNo
Authorized OfficialPaul Stephen NicholsonAo · (410) 337-1602
Enumeration DateApril 24, 2024
NPPES CertifiedApril 24, 2024
✔ NPI 1093561771 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
125 SHORE WAY DR, Queenstown, MD 21658
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D2332981

University Of Maryland Community Medical Group · Queenstown, MD
Active · expires Oct 27, 2027
CLIA Number21D2332981
Laboratory TypePhysician Office
Certificate Effective DateOctober 28, 2025
Certificate Expiration DateOctober 27, 2027
Laboratory DirectorChristy Marciniak
Laboratory Phone(667) 343-7560
Laboratory LocationUniversity Of Maryland Community Medical Group125 Shoreway Drive Suite 330, Queenstown, MD 21658
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 21D2129919

University Of Maryland Community Medical Group · Queenstown, MD
Active · expires Apr 27, 2027
CLIA Number21D2129919
Laboratory TypePhysician Office
Certificate Effective DateApril 28, 2025
Certificate Expiration DateApril 27, 2027
Laboratory DirectorPalak Doshi
Laboratory Phone(410) 822-7040
Laboratory LocationUniversity Of Maryland Community Medical Group125 Shoreway Dr Suite 210, Queenstown, MD 21658
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 University Of Maryland Community Medical Group, Inc.'s NPI number?

The NPI number for University Of Maryland Community Medical Group, Inc. is 1093561771. It was assigned to this organization in the NPPES registry on April 24, 2024.

Where is University Of Maryland Community Medical Group, Inc. located?

University Of Maryland Community Medical Group, Inc. is located at 125 Shore Way Dr Suite 240, Queenstown, MD 21658. The listed phone number is (410) 758-8776.

What is University Of Maryland Community Medical Group, Inc.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does University Of Maryland Community Medical Group, Inc. hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for University Of Maryland Community Medical Group, Inc. was last updated on April 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.