Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D83600 | MD |
Y | 2080P0203X | Pediatric Critical Care Doctor | D83600 | MD |
NPI | 1043641921 |
---|---|
Provider Name | Dr. Yudy Astrid Fonseca |
First Address | Baltimore, MD 21264-2063 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2013 |
Last Update Date | 29/10/2019 |