Provider Demographics
NPI:1043274905
Name:RADIATION ONCOLOGY SERVICES OF NORTHWEST BALTIMORE, LLC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY SERVICES OF NORTHWEST BALTIMORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-601-5681
Mailing Address - Street 1:PO BOX 17225
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297
Mailing Address - Country:US
Mailing Address - Phone:410-601-5681
Mailing Address - Fax:410-601-5690
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-601-5681
Practice Address - Fax:410-601-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD605LMedicare ID - Type Unspecified