Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 9983 | MD |
NPI | 1588788707 |
---|---|
Provider Name | Dr. Laura A Perell |
First Address | Towson, MD 21286-5419 |
Second Address | Towson, MD 21286-5419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V450 | BLUE SHIELD OF MD (01) | MD |