Healthcare Provider Details

I. General information

NPI: 1336307230
Provider Name (Legal Business Name): ELIASSON MEDICAL SYSTEMS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD SUITE 208
BALTIMORE MD
21237-4329
US

IV. Provider business mailing address

9106 PHILADELPHIA RD SUITE 208
BALTIMORE MD
21237-4329
US

V. Phone/Fax

Practice location:
  • Phone: 410-391-0646
  • Fax: 410-391-8565
Mailing address:
  • Phone: 410-391-0646
  • Fax: 410-391-8565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD31076
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD31076
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD31076
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberD31076
License Number StateMD

VIII. Authorized Official

Name: DR. ORN, ELIASSON
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 410-391-0646