Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 01468 | MD |
NPI | 1538177746 |
---|---|
Provider Name | Mildred Sartee Prah |
First Address | Baltimore, MD 21228-4873 |
Second Address | Springfield, VA 22150-4446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 24/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01468 | MD PODIATRY LICENSE (01) | MD |