Provider Demographics
NPI:1598972259
Name:BALTIMORE ONCOLOGY HEMATOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:BALTIMORE ONCOLOGY HEMATOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-338-7472
Mailing Address - Street 1:5118 HOLLY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1191
Mailing Address - Country:US
Mailing Address - Phone:240-338-7472
Mailing Address - Fax:
Practice Address - Street 1:821 N EUTAW ST STE 206
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-6302
Practice Address - Country:US
Practice Address - Phone:410-246-4450
Practice Address - Fax:410-617-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332900000X
MDBK7654076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K965OtherFEDERAL BCBS OF DC
MD510806300Medicaid
MD368CBAOtherBCBS OF MARYLAND
250NMedicare PIN