Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | D0031551 | MD |
NPI | 1114994373 |
---|---|
Provider Name | Dr. Russell R. Deluca |
First Address | Baltimore, MD 21225-1233 |
Second Address | Baltimore, MD 21225-1233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210121100 | (05) | MD |
D72047 | (02) | MD |