Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | D41128 | MD |
NPI | 1003865106 |
---|---|
Provider Name | Arjun S Chanmugam |
First Address | Baltimore, MD 21264-4362 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 15/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
594941600 | (05) | MD |
F65866 | (02) | MD |