| NPI | 1104818871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA DODSON Credentialing Manager 443-398-0189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0033079) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2024-08-06 |