Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 78 | MD |
N | 1223P0106X | Oral and Maxillofacial Pathology | 78 | MD |
NPI | 1588096721 |
---|---|
Provider Name | Ana Cotrim |
First Address | Bethesda, MD 20814-3974 |
Second Address | Bethesda, MD 20892-1190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2013 |
Last Update Date | 30/07/2013 |