Healthcare Provider Details

I. General information

NPI: 1972564136
Provider Name (Legal Business Name): ORLANDO B CONANAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 LIBERTY RD
BALTIMORE MD
21207-3870
US

IV. Provider business mailing address

5401 OLD COURT RD ATTN: CREDENTIALING
RANDALLSTOWN MD
21133-5103
US

V. Phone/Fax

Practice location:
  • Phone: 410-265-5114
  • Fax: 410-265-8858
Mailing address:
  • Phone: 410-601-5524
  • Fax: 410-601-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD19502
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD19502
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: