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General NPI Number Information
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NPI Number | 1598732851
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Entity Type | Individual
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Provider Name | BENJAMIN BALTAZAR BANDONG MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1501 DIVISION STREET
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City | BALTIMORE
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State | MD
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Zip | 21217
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Country | US
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Telephone | 410-383-8300
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Fax | 410-728-4412
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Provider Business Mailing Address
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Address Line | 308 PATLEIGH ROAD
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City | CATONSVILLE
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State | MD
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Zip | 21228-5630
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Country | US
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Telephone | 410-788-8875
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Fax | 410-747-4237
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0016938
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License Number State | MD
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