Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | M00338 | MD |
NPI | 1548343437 |
---|---|
Provider Name | Arnold R Forman |
First Address | Dundalk, MD 21222-1438 |
Second Address | Dundalk, MD 21222-1438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T59508 | (02) |