Healthcare Provider Details

I. General information

NPI: 1508943408
Provider Name (Legal Business Name): YORAM TAL UNGURU M.D., M.S., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215
US

IV. Provider business mailing address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5864
  • Fax: 410-601-6027
Mailing address:
  • Phone: 410-601-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD036047
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: