Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | D0041547 | MD |
N | 207VE0102X | Reproductive Endocrinologist | ME62580 | FL |
NPI | 1255360962 |
---|---|
Provider Name | Dr. Simon Kipersztok |
First Address | Annapolis, MD 21401-3046 |
Second Address | Annapolis, MD 21401-3046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B86037 | (02) |