Healthcare Provider Details

I. General information

NPI: 1598972259
Provider Name (Legal Business Name): BALTIMORE ONCOLOGY HEMATOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N EUTAW ST STE 206
BALTIMORE MD
21201-6302
US

IV. Provider business mailing address

5118 HOLLY CREEK LN
CLARKSVILLE MD
21029-1191
US

V. Phone/Fax

Practice location:
  • Phone: 410-246-4450
  • Fax: 410-617-8326
Mailing address:
  • Phone: 240-338-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberBK7654076
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: KAVITA KALRA
Title or Position: PRESIDENT
Credential:
Phone: 240-338-7472