Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 222859 | MD |
NPI | 1427549906 |
---|---|
Provider Name | Melody A Robinson |
First Address | Waldorf, MD 20603-3215 |
Second Address | Waldorf, MD 20603-4759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2018 |
Last Update Date | 21/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
222859 | LICENSE (01) | MD |