Healthcare Provider Details

I. General information

NPI: 1326222159
Provider Name (Legal Business Name): EDWARD ALLAN RACELA SISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ORLEANS ST ROOM 2M46
BALTIMORE MD
21287-0013
US

IV. Provider business mailing address

1650 ORLEANS ST ROOM 2M46
BALTIMORE MD
21287-0013
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8751
  • Fax:
Mailing address:
  • Phone: 410-955-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberD67799
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: