Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | D59756 | MD |
NPI | 1235163619 |
---|---|
Provider Name | Lee Fireman |
First Address | Baltimore, MD 21237-3901 |
Second Address | Baltimore, MD 21237-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H80751 | (02) | MD |