Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | D57752 | MD |
NPI | 1164462552 |
---|---|
Provider Name | Forrest T Closson |
First Address | Baltimore, MD 21264-2063 |
Second Address | Baltimore, MD 21201-1513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 10/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
769802000 | (05) | MD |
H42043 | (02) |