Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | D0020618 | MD |
Y | 225400000X | Rehabilitation Practitioner | D0020618 | MD |
NPI | 1053371310 |
---|---|
Provider Name | Dr. Martin Zelig Kanner |
First Address | Baltimore, MD 21208-6391 |
Second Address | Baltimore, MD 21208-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 24/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132481100 | (05) | MD |
AK7595551 | FEDERAL DEA (01) | MD |
B70288 | (02) | MD |
D0020618 | STATE LICENSE (01) | MD |
M04706 | STATE DEA (01) | MD |