Healthcare Provider Details

I. General information

NPI: 1902840713
Provider Name (Legal Business Name): JOHN B ODONNELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N CALVERT ST STE 400
BALTIMORE MD
21218
US

IV. Provider business mailing address

3333 N CALVERT ST STE 400
BALTIMORE MD
21218
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2270
  • Fax: 410-261-2726
Mailing address:
  • Phone: 410-554-2270
  • Fax: 410-261-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD35423
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: