Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | D0039805 | MD |
N | 208000000X | Pediatrician | D0039805 | MD |
N | 2080N0001X | Neonatal-Perinatal Doctor | D0039805 | MD |
NPI | 1780615427 |
---|---|
Provider Name | Christiane Theda |
First Address | Frederick, MD 21704-6865 |
Second Address | Baltimore, MD 21287-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G13062 | (02) | MD |