Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036140029 | IL |
N | 111NI0900X | Internist | 036140029 | IL |
N | 207RA0201X | Internist - Allergy & Immunology | 036140029 | IL |
Y | 207RA0201X | Internist - Allergy & Immunology | D87781 | MD |
NPI | 1942543541 |
---|---|
Provider Name | Melanie Claire Dispenza |
First Address | Baltimore, MD 21236-4902 |
Second Address | Baltimore, MD 21224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2013 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036140029 | MEDICAL LICENSE (01) | IL |