Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 01063072A | IN |
Y | 207YS0123X | Facial Plastic Surgeon | D67391 | MD |
NPI | 1164624763 |
---|---|
Provider Name | Dr. Henry Daniel Sandel IV |
First Address | Annapolis, MD 21401-7114 |
Second Address | Annapolis, MD 21401-7114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 24/07/2008 |