Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | D0027276 | MD |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | D0027276 | MD |
NPI | 1609814326 |
---|---|
Provider Name | Dr. Marcella Lila Roenneburg |
First Address | Salisbury, MD 21802-1978 |
Second Address | Salisbury, MD 21804-8502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119591300 | (05) | MD |