Provider Demographics
NPI:1790805968
Name:HEPEL, JAROSLAW (MD)
Entity Type:Individual
Prefix:
First Name:JAROSLAW
Middle Name:
Last Name:HEPEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64984
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4984
Mailing Address - Country:US
Mailing Address - Phone:443-849-2540
Mailing Address - Fax:443-849-2595
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-2540
Practice Address - Fax:443-849-2595
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2232802085R0001X
RIMD130552085R0001X
MDD00690262085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022366200Medicaid
MDS325Medicare PIN