Provider Demographics
NPI:1770519506
Name:BATES, HOWARD R (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:R
Last Name:BATES
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 1:301 ST. PAUL PLACE
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 ST. PAUL PLACE
Practice Address - Street 2:3RD FLOOR, NUCLEAR MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-332-9177
Practice Address - Fax:410-347-1172
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015196207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD903205300Medicaid
MDS187 / S187OtherBLUECHOICE
MDS796 / 611305-01OtherBC / BS OF MD
MDS187 / S187OtherBLUECHOICE
S796 / 80QQMedicare ID - Type Unspecified