Healthcare Provider Details

I. General information

NPI: 1437173036
Provider Name (Legal Business Name): SURGICAL ONCOLOGY ASSOCIATES MD-PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE FIRST FLOOR, MAIN
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

2401 W BELVEDERE AVE FIRST FLOOR, MAIN
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8317
  • Fax: 410-601-9345
Mailing address:
  • Phone: 410-601-8317
  • Fax: 410-601-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MUKUND S DIDOLKAR
Title or Position: DIRECTOR, SURGICAL ONCOLOGY
Credential: M.D.
Phone: 410-601-8317