Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 051467 | NY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 256892 | NY |
NPI | 1013107572 |
---|---|
Provider Name | Dr. Donita Dyalram |
First Address | Baltimore, MD 21201-1510 |
Second Address | Baltimore, MD 21201-1510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 24/07/2012 |