Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 16224 | MD |
N | 222Z00000X | Podiatrist | 16224 | MD |
Y | 225100000X | Physical Therapist | 16224 | MD |
N | 2251H1200X | Hand | 16224 | MD |
NPI | 1245210970 |
---|---|
Provider Name | Gary D. Kassimir |
First Address | Pikesville, MD 21208-1306 |
Second Address | Pikesville, MD 21208-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 07/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
590500100 | (05) | MD |
R12190 | (02) | MD |