Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D77745 | MD |
N | 111NI0900X | Internist | D77745 | MD |
Y | 207RA0201X | Internist - Allergy & Immunology | D77745 | MD |
NPI | 1912168113 |
---|---|
Provider Name | Dr. Eric Tyrell Oliver |
First Address | Baltimore, MD 21224-6801 |
Second Address | Baltimore, MD 21224-6801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 28/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D77745 | LICENSE (01) | MD |