Healthcare Provider Details

I. General information

NPI: 1508086521
Provider Name (Legal Business Name): EUTAW ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N EUTAW ST ST 305
BALTIMORE MD
21201-4648
US

IV. Provider business mailing address

PO BOX 309
WESTMINSTER MD
21158-0309
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-5148
  • Fax:
Mailing address:
  • Phone: 410-876-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0029071
License Number StateMD

VIII. Authorized Official

Name: PHILIP HOWARD KONITS
Title or Position: PRESIDENT
Credential: MD
Phone: 410-876-5148