Provider Demographics
NPI:1497859763
Name:HARRELL, ANTHONY J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3100 WYMAN PARK DR
Mailing Address - Street 2:STE 359A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:410-288-4800
Mailing Address - Fax:410-338-3420
Practice Address - Street 1:2112 DUNDALK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222
Practice Address - Country:US
Practice Address - Phone:410-288-4800
Practice Address - Fax:410-288-2475
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2013-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD34749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD477851100Medicaid
MD477851100Medicaid
B69509Medicare UPIN