Provider Demographics
NPI:1750389870
Name:DIDOLKAR, MUKUND S (MD)
Entity type:Individual
Prefix:DR
First Name:MUKUND
Middle Name:S
Last Name:DIDOLKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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 1:2435 W BELVEDERE AVE
Practice Address - Street 2:SUITE 46
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5224
Practice Address - Country:US
Practice Address - Phone:410-601-8317
Practice Address - Fax:410-601-9345
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDM111712086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD460000200Medicaid
MD460000200Medicaid
B66785Medicare UPIN