Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D77033 | MD |
Y | 2080P0203X | Pediatric Critical Care Doctor | D77033 | MD |
N | 2080P0203X | Pediatric Critical Care Doctor | E-3101 | AR |
NPI | 1295825792 |
---|---|
Provider Name | Adnan Bhutta |
First Address | Baltimore, MD 21264-2063 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 15/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
148565001 | (05) | AR |
H60324 | (02) |