Provider Demographics
NPI:1821271032
Name:MARYLAND ONCOLOGY HEMATOLOGY, P.A.
Entity Type:Organization
Organization Name:MARYLAND ONCOLOGY HEMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:K
Authorized Official - Last Name:MINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-964-2212
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE G020
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-964-2212
Mailing Address - Fax:410-964-1111
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE G020
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-964-2212
Practice Address - Fax:410-964-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215868OtherMEDICARE PTAN
MDDR6644OtherMEDICARE RAILROAD PTAN