Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3898 | MD |
Y | 103T00000X | Psychologist | 3898 | MD |
NPI | 1013075266 |
---|---|
Provider Name | Dr. Mark Douglas Springston |
First Address | Frederick, MD 21704-7624 |
Second Address | Frederick, MD 21704-7769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 16/11/2015 |