Healthcare Provider Details

I. General information

NPI: 1508006230
Provider Name (Legal Business Name): BENJAMIN MCGUINNESS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-3093
  • Fax: 410-614-8238
Mailing address:
  • Phone: 410-502-3093
  • Fax: 410-614-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberUNKNOWN
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: