Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R 120622 | MD |
NPI | 1023093549 |
---|---|
Provider Name | Mr. Patrick George |
First Address | Glen Burnie, MD 21060-7607 |
Second Address | Baltimore, MD 21224-5238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q 39646 | (02) | MD |