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General NPI Number Information
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NPI Number | 1538546262
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Entity Type | Organization
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Legal Business Name | SKIN CANCER EB, LLC
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 300 REDLAND CT SUITE 101
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3271
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Country | US
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Telephone | 410-591-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 1903 CORBRIDGE LN
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City | MONKTON
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State | MD
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Zip | 21111-2027
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Country | US
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Telephone | 410-591-6910
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. VLADIMIR IOFFE
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Credential | M.D.
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Telephone | 410-591-6910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | D63835
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License Number State | MD
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