Healthcare Provider Details

I. General information

NPI: 1912977984
Provider Name (Legal Business Name): RADIATION ONCOLOGY AFFILIATES OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 FRANKLIN SQUARE DR SUITE 100
BALTIMORE MD
21237-3930
US

IV. Provider business mailing address

9105 FRANKLIN SQUARE DR SUITE 100
BALTIMORE MD
21237-3930
US

V. Phone/Fax

Practice location:
  • Phone: 410-682-6800
  • Fax: 410-682-2783
Mailing address:
  • Phone: 410-682-6800
  • Fax: 410-682-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JANE GONTER
Title or Position: VICE-PRESIDENT
Credential:
Phone: 410-682-6800