Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D0054379 | MD |
NPI | 1003806449 |
---|---|
Provider Name | Kathy Linne Von Berg |
First Address | Baltimore, MD 21218-2608 |
Second Address | Baltimore, MD 21218-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 21/07/2007 |