Provider Demographics
NPI:1750327441
Name:ANKROM, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:ANKROM
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 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 N CHARLES ST STE 4105
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-3184
Practice Address - Fax:443-849-3182
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD159611000Medicaid
MD10580OtherJOHNS HOPKINS HEALTH CARE
MD533474-07OtherCARE FIRST BLUE CROSS
MD489769OtherNCPPO
MD5128096OtherCIGNA
MD5826487OtherAETNA PPO
MD3985180OtherAETNA HMO
DCO242-0020OtherCARE FIRST BLUE CROSS
MD4432OtherBRAVO /ELDERHEALTH
MD489769OtherNCPPO
MD712L188769YBPGMedicare PIN
MD110233498Medicare PIN
MD10580OtherJOHNS HOPKINS HEALTH CARE
MD3985180OtherAETNA HMO