Healthcare Provider Details

I. General information

NPI: 1194317941
Provider Name (Legal Business Name): MARYLAND ONCOLOGY HEMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9905 MEDICAL CENTER DR STE 200
ROCKVILLE MD
20850-6535
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:
Mailing address:
  • Phone: 410-241-1657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LISA TALBOTT
Title or Position: PRACTICE DIRECTOR
Credential:
Phone: 410-952-8421