Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D38038 | MD |
NPI | 1083720445 |
---|---|
Provider Name | Dr. Sharon Ellen Neibel-Pondek |
First Address | Bel Air, MD 21015-6134 |
Second Address | Bel Air, MD 21014-2330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208000000X | TAXONOMY NUMBER (01) | MD |
522272246 | TAX ID # (01) | MD |
543711300 | (05) | MD |
D38038 | STATE LICENSE NUMBER (01) | MD |
E31681 | (02) | MD |