Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | D0076418 | MD |
NPI | 1093810582 |
---|---|
Provider Name | Keshav Tandav Magge |
First Address | Bethesda, MD 20817-1847 |
Second Address | Canton, OH 44710-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 10/02/2016 |