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General NPI Number Information
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NPI Number | 1194967091
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Entity Type | Individual
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Provider Name | EVAN MARK BRAUNSTEIN M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 401 NORTH BROADWAY ROOM 1363
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City | BALTIMORE
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State | MD
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Zip | 21231-1146
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Country | US
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Telephone | 410-955-8893
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Fax | 410-955-8587
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-6421
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Fax | 410-955-8587
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | D72008
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License Number State | MD
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