Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | D26511 | MD |
NPI | 1336182286 |
---|---|
Provider Name | Barbara A Fivush |
First Address | Baltimore, MD 21264-4316 |
Second Address | Baltimore, MD 21287-0006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B70705 | (02) | MD |