Healthcare Provider Details

I. General information

NPI: 1992799027
Provider Name (Legal Business Name): MICHAEL RADOWSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD GOOD SAMARITAN HOSPITAL SUITE 206
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

8606 SNOWREATH RD
PIKESVILLE MD
21208-6337
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-4445
  • Fax: 410-433-0504
Mailing address:
  • Phone: 410-484-8486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0022594
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: