Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D89024 | MD |
N | 111NI0900X | Internist | D89024 | MD |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | D89024 | MD |
NPI | 1043673213 |
---|---|
Provider Name | Kevin William O'malley |
First Address | Baltimore, MD 21236-4902 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 18/08/2020 |