Healthcare Provider Details

I. General information

NPI: 1255663209
Provider Name (Legal Business Name): MICHAEL RADOWSKY M.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD #206
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD #206
BALTIMORE MD
21239-2905
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-4445
  • Fax: 410-433-0504
Mailing address:
  • Phone: 410-433-4445
  • Fax: 410-433-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD00 22594
License Number StateMD

VIII. Authorized Official

Name: DR. MICHAEL RADOWSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-433-4445