Healthcare Provider Details

I. General information

NPI: 1275827891
Provider Name (Legal Business Name): MARYLAND ONCOLOGY HEMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 V TWIN DR SUITE 104
GETTYSBURG PA
17325-7875
US

IV. Provider business mailing address

10710 CHARTER DR SUITE G020
COLUMBIA MD
21044-3128
US

V. Phone/Fax

Practice location:
  • Phone: 717-338-9009
  • Fax: 717-334-1514
Mailing address:
  • Phone: 410-964-2212
  • Fax: 410-964-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD30573
License Number StateMD

VIII. Authorized Official

Name: JON MINFORD
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 410-964-2212