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General NPI Number Information
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NPI Number | 1003889882
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Entity Type | Individual
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Provider Name | RICHARD LOUIS BANCELLS A.T.,C.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ORIOLE PARK AT CAMDEN YARDS 333 WEST CAMDEN ST.
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City | BALTIMORE
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State | MD
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Zip | 21210
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Country | US
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Telephone | 410-685-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 21300 LENTZ RD
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City | PARKTON
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State | MD
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Zip | 21120-9130
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Country | US
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Telephone | 410-357-8906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AL 651
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License Number State | FL
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