Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | D0077774 | MD |
Y | 207QA0401X | Family Doctor - Addiction Medicine | D0077774 | MD |
NPI | 1013208198 |
---|---|
Provider Name | Aaron David Greenblatt |
First Address | Baltimore, MD 21201-1642 |
Second Address | Baltimore, MD 21223-2679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 27/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I20140214000915 | (02) | CA |
RES000 | (02) | CA |