Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D72659 | MD |
Y | 2080N0001X | Neonatal-Perinatal Doctor | D72659 | MD |
NPI | 1023277670 |
---|---|
Provider Name | Kiron Mallya |
First Address | Baltimore, MD 21264-2063 |
Second Address | Baltimore, MD 21201-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2008 |
Last Update Date | 02/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
044129500 | (05) | MD |