Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 057505 | GA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 0101054810 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 057505 | GA |
N | 207ND0101X | MOHS-Micrographic Surgeon | D0067264 | MD |
Y | 207ND0101X | MOHS-Micrographic Surgeon | D67264 | MD |
N | 207ND0900X | Dermatopathologist | 057505 | GA |
N | 207NP0225X | Pediatric Dermatologist | 057505 | GA |
N | 207NS0135X | Procedural Dermatology | 057505 | GA |
N | 208D00000X | General Practice Physician | 057505 | GA |
NPI | 1508846817 |
---|---|
Provider Name | Dr. Charles Bradie Toner |
First Address | Bethesda, MD 20817-7811 |
Second Address | Clinton, MD 20735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 21/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14994 | (02) | GU |