Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 15727 | MD |
NPI | 1154686228 |
---|---|
Provider Name | Dr. Tontesh Shivakumar Tawady |
First Address | Lutherville, MD 21093-6217 |
Second Address | Lutherville, MD 21093-6217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 06/07/2016 |