Provider Demographics
NPI:1376534222
Name:HAUSNER, PETR FRANTISEK (MD)
Entity Type:Individual
Prefix:DR
First Name:PETR
Middle Name:FRANTISEK
Last Name:HAUSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62602
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2602
Mailing Address - Country:US
Mailing Address - Phone:410-328-2567
Mailing Address - Fax:410-328-6896
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-2567
Practice Address - Fax:410-328-6896
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD48160207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD964910700Medicaid
MD547630-01OtherBLUE CROSS/BLUE SHIELD
DE0001188001Medicaid
MD964910700Medicaid
MD547630-01OtherBLUE CROSS/BLUE SHIELD
MD349L003VMedicare PIN