Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3743 | MD |
Y | 103T00000X | Psychologist | 3743 | MD |
N | 102L00000X | Psychologist | PS005773L | PA |
N | 103T00000X | Psychologist | PS005773L | PA |
NPI | 1003024043 |
---|---|
Provider Name | Dr. Kevin Eli Favor |
First Address | Forest Hill, MD 21050-2645 |
Second Address | Forest Hill, MD 21050-2645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |