Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D91392 | MD |
NPI | 1336503382 |
---|---|
Provider Name | Dr. William Vanderveer Probasco |
First Address | Baltimore, MD 21202-2102 |
Second Address | Baltimore, MD 21202-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 21/07/2021 |