Healthcare Provider Details

I. General information

NPI: 1144372384
Provider Name (Legal Business Name): YING WEI LUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST HARVEY 611
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

6201 GREENLEIGH AVE FL 2
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-5152
  • Fax: 410-614-2079
Mailing address:
  • Phone: 410-955-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD70744
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD70744
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: