Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | MD |
NPI | 1124770250 |
---|---|
Provider Name | Crystal Thomas |
First Address | Baltimore, MD 21239-1411 |
Second Address | Baltimore, MD 21217-2995 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |