Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | D0036878 | MD |
NPI | 1740222611 |
---|---|
Provider Name | Diane Lynn Mcdonald |
First Address | Ellicott City, MD 21043-6453 |
Second Address | Baltimore, MD 21201-1513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286931400 | (05) | MD |
E10902 | (02) | MD |