Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | D78997 | MD |
NPI | 1811029242 |
---|---|
Provider Name | Antoine Azar |
First Address | Baltimore, MD 21264-4264 |
Second Address | Baltimore, MD 21224-6821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 27/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
093272800 | (05) | MD |
7624997 | AETNA/USHC (01) | MD |