Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | D12809 | MD |
NPI | 1023197902 |
---|---|
Provider Name | Dr. Lawrence Mills JR. |
First Address | Baltimore, MD 21239-2995 |
Second Address | Baltimore, MD 21239-2995 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152711800 | (05) | MD |
BS6046 | BLUE SHIELD (01) | |
D73774 | (02) | |
T128 | BLUE CHOICE BLUE SHIELD (01) |