Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | D38909 | MD |
N | 208000000X | Pediatrician | D38909 | MD |
NPI | 1114954906 |
---|---|
Provider Name | Harry C Dietz III |
First Address | Baltimore, MD 21264-4316 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 10/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
604171000 | (05) | MD |
F47305 | (02) | MD |