Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0401412357 | VA |
NPI | 1104062835 |
---|---|
Provider Name | Dr. Mostafa Salah El Din Tolba |
First Address | Towson, MD 21204-2750 |
Second Address | Towson, MD 21204-2750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2008 |
Last Update Date | 30/12/2008 |