Provider Demographics
NPI:1255663209
Name:MICHAEL RADOWSKY M.D.P.A.
Entity Type:Organization
Organization Name:MICHAEL RADOWSKY M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-433-4445
Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:#206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2905
Mailing Address - Country:US
Mailing Address - Phone:410-433-4445
Mailing Address - Fax:410-433-0504
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:#206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-433-4445
Practice Address - Fax:410-433-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00 22594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDO 1252Medicare UPIN
MD7139MMedicare PIN