Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D0041428 | MD |
NPI | 1093782252 |
---|---|
Provider Name | Dr. Mary Jo R. Minton |
First Address | Baltimore, MD 21286-2001 |
Second Address | Baltimore, MD 21286-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BM2894245 | DEA (01) | MD |
F97667 | (02) | MD |
M32707 | CDS (01) | MD |