Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 13321 | MD |
NPI | 1124276522 |
---|---|
Provider Name | Dr. Soham Patel |
First Address | Baltimore, MD 21236-4931 |
Second Address | Baltimore, MD 21236-4931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 28/08/2008 |