MEDICARE: DAVID SIDRANSKY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D36597	MD
2	207RX0202X	Medical Oncology Physician	D36597	MD
3	207Y00000X	Otolaryngology Physician	D36597	MD

General Provider Information

NPI Number	:	1629147863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SIDRANSKY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 64588
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4588
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 RUTLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-2109
Country	:	US
Telephone Number	:	410-502-5153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	09/11/2025

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