Provider Demographics
NPI:1700080439
Name:MAVANUR, ARUN A (MD)
Entity Type:Individual
Prefix:
First Name:ARUN
Middle Name:A
Last Name:MAVANUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:1ST FLOOR MAIN
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-8317
Mailing Address - Fax:410-601-9345
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:1ST FLOOR MAIN
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-8317
Practice Address - Fax:410-601-9345
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2010-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00712742086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0071274OtherSTATE LICENSE