Healthcare Provider Details

I. General information

NPI: 1528316601
Provider Name (Legal Business Name): JIAN ZHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

1519 MELTON RD
LUTHERVILLE MD
21093-5847
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-7490
  • Fax:
Mailing address:
  • Phone: 410-205-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0079977
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP28028
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: