Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215441696 |
---|---|
Provider Name | Dovid Pinchus Berkovits |
First Address | Baltimore, MD 21209-1435 |
Second Address | Baltimore, MD 21208-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2017 |
Last Update Date | 25/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
777536900 | (05) | MD |