Healthcare Provider Details

I. General information

NPI: 1629065768
Provider Name (Legal Business Name): BRENDON PALTOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 AURORA ST
CAMBRIDGE MD
21613-1903
US

IV. Provider business mailing address

105 AURORA ST
CAMBRIDGE MD
21613-1903
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-9515
  • Fax: 410-228-1453
Mailing address:
  • Phone: 410-228-9515
  • Fax: 410-228-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD57040
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: