Healthcare Provider Details

I. General information

NPI: 1861550774
Provider Name (Legal Business Name): MICHAEL F JAWORSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7141 SECURITY BOULEVARD
BALTIMORE MD
21244-1811
US

IV. Provider business mailing address

KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 443-663-6000
  • Fax: 443-663-6172
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD15460
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: