Provider Demographics
NPI:1629065768
Name:PALTOO, BRENDON (MD)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:
Last Name:PALTOO
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 1:105 AURORA ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1903
Mailing Address - Country:US
Mailing Address - Phone:410-228-9515
Mailing Address - Fax:410-228-1453
Practice Address - Street 1:105 AURORA ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1903
Practice Address - Country:US
Practice Address - Phone:410-228-9515
Practice Address - Fax:410-228-1453
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57040207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD966604401Medicaid
MD060064602OtherRR MEDICARE
MD060064602OtherPALMETTO GBA/RAILROAD MEDICARE
MD60764602OtherCAREFIRST BS
MDE6360006OtherFEDERAL BS
H21540Medicare UPIN
MD60764602OtherCAREFIRST BS