Organization
MARYLAND ONCOLOGY HEMATOLOGY P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS W KOUTRELAKOS M.D. (PRESIDENT)
(410) 964-2212
Entity
Organization
Contact information
Practice address
10710 CHARTER DRIVE, SUITE G020, COLUMBIA, MD 21044-3257
(410) 964-2212
(410) 964-0380
Mailing address
10710 CHARTER DRIVE, SUITE G020, COLUMBIA, MD 21044-3257
(410) 964-2212
(410) 964-0380
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400899500
—
MD
Enumeration date
02/20/2006
Last updated
12/07/2010
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