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General NPI Number Information
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NPI Number | 1326222159
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Entity Type | Individual
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Provider Name | EDWARD ALLAN RACELA SISON MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1650 ORLEANS ST ROOM 2M46
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City | BALTIMORE
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State | MD
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Zip | 21287-0013
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Country | US
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Telephone | 410-955-8751
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 ORLEANS ST ROOM 2M46
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City | BALTIMORE
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State | MD
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Zip | 21287-0013
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Country | US
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Telephone | 410-955-8751
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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 | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | D67799
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License Number State | MD
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