Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 32512 | NC |
Y | 207RG0300X | Geriatric Medicine | D48215 | MD |
NPI | 1134375637 |
---|---|
Provider Name | Dr. Mark David Heuser |
First Address | Baltimore, MD 21201-1524 |
Second Address | Baltimore, MD 21201-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 15/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D29756 | (02) | NC |