Provider Demographics
NPI:1255990503
Name:TUMARKIN, ETHAN (MD)
Entity type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:
Last Name:TUMARKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EITAN
Other - Middle Name:
Other - Last Name:TUMARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 N. WOLFE ST./HALSTED 500
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-5999
Mailing Address - Fax:410-367-2406
Practice Address - Street 1:600 N. WOLFE ST./HALSTED 500
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-5999
Practice Address - Fax:410-367-2406
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT13234213-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program