Provider Demographics
NPI:1508086521
Name:EUTAW ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:EUTAW ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KONITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-876-5148
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0309
Mailing Address - Country:US
Mailing Address - Phone:410-876-5148
Mailing Address - Fax:
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:ST 305
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-876-5148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB68131Medicare UPIN
MDK398Medicare UPIN
MDC49246Medicare UPIN