Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1144481193 |
---|---|
Provider Name | Mr. Noel Smith |
First Address | Baltimore, MD 21225-2229 |
Second Address | Baltimore, MD 21225-2229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 23/06/2008 |