Healthcare Provider Details

I. General information

NPI: 1811121064
Provider Name (Legal Business Name): CHRISTOPHER JAMES VANDENBUSSCHE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2009
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST DEPARTMENT OF PATHOLOGY, PATHOLOGY 401
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR SUITE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3980
  • Fax:
Mailing address:
  • Phone: 410-933-6421
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberD77327
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: