Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | LL40885 | SC |
Y | 2080P0203X | Pediatric Critical Care Doctor | D0088859 | MD |
NPI | 1104340215 |
---|---|
Provider Name | Katherine Grace Macmillan |
First Address | Baltimore, MD 21287-0010 |
Second Address | Baltimore, MD 21287-0010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2017 |
Last Update Date | 22/04/2021 |