Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | D40854 | MD |
NPI | 1124133210 |
---|---|
Provider Name | David Andrew Riseberg |
First Address | Baltimore, MD 21202-2001 |
Second Address | Baltimore, MD 21202-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
52343402 | CAREFIRST MD (01) | |
776075 | AETNA (01) | |
E96644 | (02) | |
R8440002 | CAREFIRST DC (01) |