| NPI | 1437660511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHANA MARIA EDMONDSON Credentialing Coordinator 410-494-1324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 207W00000X Ophthalmology | |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-12-04 |