Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D0076060 | MD |
Y | 111NI0900X | Internist | D0076060 | MD |
NPI | 1003135435 |
---|---|
Provider Name | Jenna Vanliere Canzoniero |
First Address | Baltimore, MD 21201-1544 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 24/06/2013 |