Healthcare Provider Details

I. General information

NPI: 1124133210
Provider Name (Legal Business Name): DAVID ANDREW RISEBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 ST PAUL PLACE 4TH FLOOR
BALTIMORE MD
21202-2001
US

IV. Provider business mailing address

227 ST PAUL PLACE 4TH FLOOR
BALTIMORE MD
21202-2001
US

V. Phone/Fax

Practice location:
  • Phone: 410-783-5858
  • Fax: 410-783-5864
Mailing address:
  • Phone: 410-783-5858
  • Fax: 410-783-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD40854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: