Healthcare Provider Details

I. General information

NPI: 1942964333
Provider Name (Legal Business Name): MARYLAND ONCOLOGY HEMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20330 SENECA MEADOWS PKWY # B
GERMANTOWN MD
20876-7004
US

IV. Provider business mailing address

11720 BELTSVILLE DR STE 300
BELTSVILLE MD
20705-3119
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-6231
  • Fax: 301-294-4648
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DAVIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-909-3301