Provider Demographics
NPI:1336199942
Name:AUERBACH, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:AUERBACH
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 1:5233 KING AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4001
Mailing Address - Country:US
Mailing Address - Phone:410-780-4050
Mailing Address - Fax:410-780-4060
Practice Address - Street 1:5233 KING AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4001
Practice Address - Country:US
Practice Address - Phone:410-780-4050
Practice Address - Fax:410-780-4060
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033551207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404081300Medicaid
522343901OtherFEDERAL TIN
522343901OtherFEDERAL TIN
MD160M144FMedicare PIN