Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 13220 | MD |
NPI | 1205818325 |
---|---|
Provider Name | Dr. Lane T Knight |
First Address | Waldorf, MD 20602-3248 |
Second Address | Waldorf, MD 20602-3248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 08/07/2007 |