Healthcare Provider Details

I. General information

NPI: 1255742375
Provider Name (Legal Business Name): MARYLAND PROTON TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W BALTIMORE ST
BALTIMORE MD
21201-1110
US

IV. Provider business mailing address

PO BOX 65034
BALTIMORE MD
21264-5034
US

V. Phone/Fax

Practice location:
  • Phone: 410-369-5200
  • Fax: 410-347-0870
Mailing address:
  • Phone: 410-706-4919
  • Fax: 410-706-6729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMM483
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberMM483
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberMM483
License Number StateMD

VIII. Authorized Official

Name: SHAREEF MOSTAFA BATATA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 914-233-3520