Provider Demographics
NPI:1437173036
Name:SURGICAL ONCOLOGY ASSOCIATES MD-PA
Entity Type:Organization
Organization Name:SURGICAL ONCOLOGY ASSOCIATES MD-PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SURGICAL ONCOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKUND
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIDOLKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-601-8317
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:FIRST FLOOR, MAIN
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-8317
Mailing Address - Fax:410-601-9345
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:FIRST FLOOR, MAIN
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-8317
Practice Address - Fax:410-601-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD460000200Medicaid
MD659LMedicare PIN