Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | D0059479 | MD |
N | 207R00000X | Internist | D0059479 | MD |
N | 111NI0900X | Internist | D0059479 | MD |
NPI | 1336140524 |
---|---|
Provider Name | George Hennawi |
First Address | Baltimore, MD 21239-2945 |
Second Address | Baltimore, MD 21239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 13/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H85145 | (02) |