Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | D33269 | MD |
NPI | 1023378916 |
---|---|
Provider Name | Dr. Dara Dane |
First Address | Ellicott City, MD 21042-5992 |
Second Address | Baltimore, MD 21207-4575 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 24/05/2012 |