Healthcare Provider Details

I. General information

NPI: 1861536203
Provider Name (Legal Business Name): DAFNA H. KOLDOBSKIY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 WILKENS AVE STE 440
BALTIMORE MD
21229-5073
US

IV. Provider business mailing address

3407 WILKENS AVE STE 440
BALTIMORE MD
21229-5073
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-3890
  • Fax: 410-644-6517
Mailing address:
  • Phone: 410-644-3890
  • Fax: 410-644-6517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD71692
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberD71692
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: