Healthcare Provider Details

I. General information

NPI: 1487454641
Provider Name (Legal Business Name): CARROLL REGIONAL CANCER CENTER PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-6400
  • Fax: 410-871-6248
Mailing address:
  • Phone: 410-871-6400
  • Fax: 410-871-6248

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: MICHEAL MYERS
Title or Position: CFO CHC
Credential:
Phone: 410-871-6114