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General NPI Number Information
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NPI Number | 1508086521
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Entity Type | Organization
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Legal Business Name | EUTAW ONCOLOGY ASSOCIATES
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 821 N EUTAW ST ST 305
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City | BALTIMORE
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State | MD
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Zip | 21201-4648
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Country | US
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Telephone | 410-876-5148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | WESTMINSTER
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State | MD
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Zip | 21158-0309
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Country | US
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Telephone | 410-876-5148
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP HOWARD KONITS
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Credential | MD
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Telephone | 410-876-5148
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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 | D0029071
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License Number State | MD
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