Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | D0072493 | MD |
NPI | 1346363322 |
---|---|
Provider Name | Caroline S Moazzam |
First Address | Baltimore, MD 21239 |
Second Address | Baltimore, MD 21239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 12/07/2011 |