Healthcare Provider Details

I. General information

NPI: 1649247644
Provider Name (Legal Business Name): MARGARET MARY FYNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEG FYNES LOFLAND

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

PO BOX 64358
BALTIMORE MD
21264-4358
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6500
  • Fax:
Mailing address:
  • Phone: 410-356-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD058758L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD51940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: