Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D82113 | MD |
NPI | 1033238647 |
---|---|
Provider Name | Dr. William Wallace Ashley JR. |
First Address | Baltimore, MD 21209-4354 |
Second Address | Baltimore, MD 21209-4354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 11/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
520486540 | EMPLOYER TAX ID (01) | MD |