Healthcare Provider Details

I. General information

NPI: 1043274905
Provider Name (Legal Business Name): RADIATION ONCOLOGY SERVICES OF NORTHWEST BALTIMORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215
US

IV. Provider business mailing address

PO BOX 17225
BALTIMORE MD
21297
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5681
  • Fax: 410-601-5690
Mailing address:
  • Phone: 410-601-5681
  • Fax: 410-601-5690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK J BRENNER
Title or Position: HEAD PHYSICIAN
Credential: MD
Phone: 410-601-5681