Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | D61608 | MD |
NPI | 1467446344 |
---|---|
Provider Name | Dr. John F Caccamese JR. |
First Address | Baltimore, MD 21201 |
Second Address | Baltimore, MD 21201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I140704 | (02) | MD |