Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | D54458 | MD |
NPI | 1063463560 |
---|---|
Provider Name | Dr. Mark A Deitch |
First Address | Baltimore, MD 21209-3746 |
Second Address | Baltimore, MD 21209-3746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 13/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115507500 | (05) | MD |
G38218 | (02) | MD |