Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | D51185 | MD |
NPI | 1013968114 |
---|---|
Provider Name | Colleen Christmas |
First Address | Baltimore, MD 21264-4264 |
Second Address | Baltimore, MD 21224-6821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 31/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
691000900 | (05) | MD |
G43494 | (02) | MD |