Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 029607 | PA |
Y | 1223P0300X | Periodontist | 11128 | MD |
NPI | 1013222389 |
---|---|
Provider Name | Dr. Fred L Bye |
First Address | Hagerstown, MD 21742-2658 |
Second Address | Hagerstown, MD 21742-2658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2010 |
Last Update Date | 13/06/2017 |