Healthcare Provider Details

I. General information

NPI: 1891460598
Provider Name (Legal Business Name): MARYLAND ONCOLOGY HEMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 GOOD LUCK RD STE 100
LANHAM MD
20706-3502
US

IV. Provider business mailing address

11720 BELTSVILLE DR STE 300
BELTSVILLE MD
20705-3119
US

V. Phone/Fax

Practice location:
  • Phone: 301-812-3900
  • Fax: 301-474-0137
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