Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 946665 | MD |
NPI | 1235336124 |
---|---|
Provider Name | Dr. Lisa Marie Faulcon |
First Address | Baltimore, MD 21205-2109 |
Second Address | Baltimore, MD 21205-2109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 08/12/2011 |