Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | D63115 | MD |
N | 208000000X | Pediatrician | 63115 | MD |
Y | 2080P0208X | Pediatric Infectious Diseases | D63115 | MD |
NPI | 1548310220 |
---|---|
Provider Name | Dr. Matthew Brent Laurens |
First Address | Baltimore, MD 21201-1509 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 09/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012499100 | (05) | MD |