Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 7086 | MD |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7086 | MD |
NPI | 1528153798 |
---|---|
Provider Name | Mr. Timothy J Carrion |
First Address | Balto, MD 21237-2382 |
Second Address | Balto, MD 21237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T59484 | (02) |