Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 17172 | MD |
NPI | 1477668796 |
---|---|
Provider Name | Dr. James Theodore Castle |
First Address | Middle River, MD 21220-2004 |
Second Address | Baltimore, MD 21224-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17172 | MD LICENSE (01) | MD |