Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2014-10-22
- Last updated
- 2014-10-22
Specialties
Licenses
- License MD
- 22876
Location
- Practice location
- 606 HOAGIE DRIVE
- City
- BELAIR MD
- Postal code
- 21014
- Phone
- 410-420-0176
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.