Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D18394 | MD |
NPI | 1053403808 |
---|---|
Provider Name | Dr. Manuel Antonio Machiran |
First Address | Monkton, MD 21111-1433 |
Second Address | Baltimore, MD 21236-3934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B70771 | (02) | MD |