Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 10177621 | CA |
Y | 208000000X | Pediatrician | D90174 | MD |
NPI | 1003259565 |
---|---|
Provider Name | Dr. Carmel Bogle |
First Address | Baltimore, MD 21264-2063 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2013 |
Last Update Date | 22/01/2021 |