Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | D36767 | MD |
NPI | 1003851866 |
---|---|
Provider Name | Lynette Mark |
First Address | Baltimore, MD 21264-4382 |
Second Address | Baltimore, MD 21287-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
285381700 | (05) | MD |
E28714 | (02) | MD |