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General NPI Number Information
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NPI Number | 1760406482
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Entity Type | Individual
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Provider Name | MICHAEL W. PHELAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 22 S GREENE ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1544
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Country | US
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Telephone | 410-328-6897
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Fax | 410-328-2109
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Provider Business Mailing Address
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Address Line | 306 W REDWOOD ST FL 4
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City | BALTIMORE
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State | MD
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Zip | 21201-1708
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Country | US
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Telephone | 667-214-1720
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Fax | 410-706-6976
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D0060640
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | D60640
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License Number State | MD
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