Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | DOO65044 | MD |
NPI | 1255451183 |
---|---|
Provider Name | Dr. Charles William Simmons |
First Address | Owings Mills, MD 21117-5273 |
Second Address | Owings Mills, MD 21117-5273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 01/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102609154-0001 | (05) | PA |