Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | MD6692 | MD |
NPI | 1124315833 |
---|---|
Provider Name | Dr. Mark L Keiser |
First Address | Owings Mills, MD 21117-3641 |
Second Address | Owings Mills, MD 21117-3641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 01/07/2011 |