Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | D90982 | MD |
N | 2086S0122X | Plastic and Reconstructive Surgery | A167418 | CA |
NPI | 1023271152 |
---|---|
Provider Name | Judy Pan |
First Address | Middle River, MD 21220-2004 |
Second Address | Baltimore, MD 21287-0006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 17/08/2021 |