Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 9195 | MD |
NPI | 1083757157 |
---|---|
Provider Name | Dr. Marvin Baer |
First Address | Fallston, MD 21047-2205 |
Second Address | Fallston, MD 21047-1442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 16/03/2016 |