Healthcare Provider Details

I. General information

NPI: 1871872986
Provider Name (Legal Business Name): MYRON GP SLOBOGEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MYRON GP SLOBOGEAN MD

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST DIVISION OF ORTHOPAEDIC TRAUMATOLOGY
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST DIVISION OF ORTHOPAEDIC TRAUMATOLOGY
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6280
  • Fax: 410-328-6280
Mailing address:
  • Phone: 410-328-6280
  • Fax: 410-328-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number00000
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: