Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D36069 | MD |
NPI | 1083791230 |
---|---|
Provider Name | Mark A Mashburn |
First Address | Owings Mills, MD 21117-5420 |
Second Address | Owings Mills, MD 21117-5420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 25/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
484391600 | (05) | MD |
C89289 | (02) |