| NPI | 1134897424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT THOMAS Credentialing Specialist 443-383-9300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 2086S0129X | |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2022-08-26 |