Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | LL597 | MD |
NPI | 1679862007 |
---|---|
Provider Name | Dr. Ross I Couwenhoven |
First Address | Baltimore, MD 21201 |
Second Address | Baltimore, MD 21201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2011 |
Last Update Date | 06/04/2011 |