Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 15828 | MD |
Y | 2251X0800X | Physical Therapist - Orthopedic | 15828 | MD |
NPI | 1386630184 |
---|---|
Provider Name | James Mainhart |
First Address | Ellicott City, MD 21043-6074 |
Second Address | Ellicott City, MD 21043-6074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 31/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
075348300 | (05) | MD |
236396 | MAMSI (01) | MD |
4271165 | AETNA (01) | MD |
6545-0004 | BLUE CHOICE (01) | MD |
K666-AU94 | (02) | MD |