Provider Demographics
NPI:1861464265
Name:HAREWOOD, ANTHONY FITZGERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FITZGERALD
Last Name:HAREWOOD
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 1:22 S GREENE ST, DEPT OF RADIOLOGY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-3477
Mailing Address - Fax:
Practice Address - Street 1:5 GARRETT AVE, DEPT OF RADIOLOGY
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-609-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00589342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD368100900Medicaid
DC040833100Medicaid
DE2849OtherB/C B/S
MDJ062OtherB/C B/S
MD434LD721Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
MD368100900Medicaid
DEDD4343Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDJ062OtherB/C B/S
MD435LD722Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 02
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE