Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R204081 | MD |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R204081 | MD |
NPI | 1588122030 |
---|---|
Provider Name | Menachem Lasdun |
First Address | Baltimore, MD 21208-5623 |
Second Address | Baltimore, MD 21208-5623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |