Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R209333 | MD |
NPI | 1083166300 |
---|---|
Provider Name | Mr. Marco Rodrigo Oldsman |
First Address | Baltimore, MD 21201-1544 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2016 |
Last Update Date | 03/11/2016 |