Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | T7704 | MD |
NPI | 1033471099 |
---|---|
Provider Name | Brinda Muthusamy |
First Address | Ruxton, MD 21204-6679 |
Second Address | Baltimore, MD 21287-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 14/06/2012 |