Healthcare Provider Details

I. General information

NPI: 1467646687
Provider Name (Legal Business Name): AUNG & CASASNOVAS, M.D.,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD PROFESSIONAL OFFICE BUILDING, SUITE#402
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

PO BOX 20089
BALTIMORE MD
21284-0089
US

V. Phone/Fax

Practice location:
  • Phone: 410-464-5700
  • Fax: 410-464-5701
Mailing address:
  • Phone: 410-464-5700
  • Fax: 410-464-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CHAN AUNG
Title or Position: PRESIDENT
Credential: M.D.,FAAP.
Phone: 410-464-5700