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General NPI Number Information
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NPI Number | 1073491916
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Entity Type | Organization
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Legal Business Name | MARYLAND ONCOLOGY HEMATOLOGY
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 6505 BELCREST RD STE 110
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City | HYATTSVILLE
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State | MD
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Zip | 20782-2011
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Country | US
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Telephone | 301-779-8800
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Fax | 202-636-9088
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Provider Business Mailing Address
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Address Line | 11720 BELTSVILLE DR STE 300
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City | BELTSVILLE
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State | MD
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Zip | 20705-3119
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Country | US
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Telephone | 240-223-1869
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Fax |
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Authorized Official
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Title or Position | DIRECTOR MANAGED CARE
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Name | KYLE BLACK
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Credential |
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Telephone | 610-442-2026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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