Individual ProviderDmitry TrifanovRadiologyAllopathic & Osteopathic PhysiciansPractice Address600 N Wolfe St, Baltimore, MD 21287-0005(410) 955-5000(410) 933-6423PECOS EnrollmentBased on the most recent information from CMS, provider Dmitry Trifanov is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1386024107Provider TypeIndividualFull NameTrifanov, DmitryCredentialMDGenderMaleSole ProprietorNoEnumeration Date6/6/2015Last Updated6/29/2020Contact InformationPractice LocationPractice Address600 N Wolfe St, Baltimore, MD 21287-0005Phone(410) 955-5000FaxUnlisted FaxMailing LocationMailing Address9910 Franklin Square Dr Ste 2110, Baltimore, MD 21236-4902Phone(410) 933-6423FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseD88973Maryland