Healthcare Provider Details

I. General information

NPI: 1316254246
Provider Name (Legal Business Name): MICHAEL E PELCZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

133 RIVER RUN
QUEENSTOWN MD
21658-1642
US

V. Phone/Fax

Practice location:
  • Phone: 410-827-8860
  • Fax:
Mailing address:
  • Phone: 410-827-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License NumberDO9990
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: