Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD043413L | PA |
NPI | 1194724419 |
---|---|
Provider Name | Dr. William Paul Lavietes |
First Address | Baltimore, MD 21209-3770 |
Second Address | Baltimore, MD 21209-3770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 02/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E72791 | (02) |