Healthcare Provider Details

I. General information

NPI: 1114001138
Provider Name (Legal Business Name): MEHMET KOCOGLU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 62602
BALTIMORE MD
21264-2602
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-2632
  • Fax: 410-328-6896
Mailing address:
  • Phone: 410-328-2632
  • Fax: 410-328-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE-4928
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD78398
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: