Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | D60613 | MD |
Y | 207RX0202X | Medical Oncology | D60613 | MD |
NPI | 1003851577 |
---|---|
Provider Name | Kala Visvanathan |
First Address | Baltimore, MD 21264-4474 |
Second Address | Baltimore, MD 21287-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 20/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
403092300 | (05) | MD |
H96266 | (02) | MD |