Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D0036634 | MD |
NPI | 1205984796 |
---|---|
Provider Name | Dr. Michael L Zollicoffer |
First Address | Baltimore, MD 21215-4749 |
Second Address | Baltimore, MD 21215-4749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |