Healthcare Provider Details

I. General information

NPI: 1376534222
Provider Name (Legal Business Name): PETR FRANTISEK HAUSNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 62602
BALTIMORE MD
21264-2602
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-2567
  • Fax: 410-328-6896
Mailing address:
  • Phone: 410-328-2567
  • Fax: 410-328-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD48160
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: