Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | D0088616 | MD |
NPI | 1134767643 |
---|---|
Provider Name | Mohammad Mofreh S Altaleb |
First Address | Baltimore, MD 21202 |
Second Address | Baltimore, MD 21287-0882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2019 |
Last Update Date | 16/12/2019 |