Facts
- Status
- A
- Credential
- OTR
- Type
- Individual
- Enumeration date
- 2007-05-15
- Last updated
- 2007-07-09
Specialties
Licenses
- License MD
- 01516
Location
- Practice location
- 15115 EASTVIEW DR
- City
- UPPERCO MD
- Postal code
- 211559746
- Phone
- 410-429-1906
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.