Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | R156307 | MD |
NPI | 1134114101 |
---|---|
Provider Name | Justina Debella Mammeri |
First Address | Baltimore, MD 21202-2102 |
Second Address | Pikesville, MD 21208-6391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 16/06/2010 |