Healthcare Provider Details

I. General information

NPI: 1831331644
Provider Name (Legal Business Name): DANIEL KEJZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ORLEANS STREET
BALTIMORE MD
21231-1000
US

IV. Provider business mailing address

6709 DARWOOD DR
BALTIMORE MD
21209-1405
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-3511
  • Fax:
Mailing address:
  • Phone: 443-562-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberP23286
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: