Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | D87894 | MD |
N | 207R00000X | Internist | D87894 | MD |
N | 111NI0900X | Internist | D87894 | MD |
NPI | 1174940019 |
---|---|
Provider Name | Leanna-Marie Robertson |
First Address | Baltimore, MD 21204-5801 |
Second Address | Hunt Valley, MD 21065-9998 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 20/12/2021 |