Healthcare Provider Details

I. General information

NPI: 1194967091
Provider Name (Legal Business Name): EVAN MARK BRAUNSTEIN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NORTH BROADWAY ROOM 1363
BALTIMORE MD
21231-1146
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8893
  • Fax: 410-955-8587
Mailing address:
  • Phone: 410-933-6421
  • Fax: 410-955-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD72008
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: