Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D0057725 | MD |
NPI | 1104894781 |
---|---|
Provider Name | Dr. Ira Martin Garonzik |
First Address | Baltimore, MD 21209-4354 |
Second Address | Baltimore, MD 21209-4354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 08/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H63595 | (02) | MD |