Healthcare Provider Details

I. General information

NPI: 1023330792
Provider Name (Legal Business Name): MICHAEL O. MAGAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SISTER PIERRE DR SUITE 303
TOWSON MD
21204-7516
US

IV. Provider business mailing address

120 SISTER PIERRE DR SUITE 303
TOWSON MD
21204-7516
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-9003
  • Fax: 410-337-9005
Mailing address:
  • Phone: 410-337-9003
  • Fax: 410-337-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0012429
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier05225-1100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: DR. MICHAEL OSWALD MAGAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-337-9003