Healthcare Provider Details

I. General information

NPI: 1346977568
Provider Name (Legal Business Name): COLUM DENNEHY MB BCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2022
Last Update Date: 08/07/2022
Certification Date: 08/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ORLEANS ST
BALTIMORE MD
21287-0013
US

IV. Provider business mailing address

1211 S EATON ST UNIT 6040
BALTIMORE MD
21224-4381
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-2491
  • Fax:
Mailing address:
  • Phone: 410-804-2585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number409182
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: