Provider Demographics
NPI:1023330792
Name:MICHAEL O. MAGAN MD PA
Entity type:Organization
Organization Name:MICHAEL O. MAGAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OSWALD
Authorized Official - Last Name:MAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-337-9003
Mailing Address - Street 1:120 SISTER PIERRE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7516
Mailing Address - Country:US
Mailing Address - Phone:410-337-9003
Mailing Address - Fax:410-337-9005
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-337-9003
Practice Address - Fax:410-337-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0012429207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05225-1100Medicaid
MD05225-1100Medicaid