Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | D0006588 | MD |
NPI | 1124186176 |
---|---|
Provider Name | Dr. Melvin Joel Kordon |
First Address | Ellicott City, MD 21042-6314 |
Second Address | Ellicott City, MD 21042-6314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B66686 | (02) | MD |