Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | D0040743 | MD |
NPI | 1558479394 |
---|---|
Provider Name | Mrs. Theda Christine Kontis |
First Address | Baltimore, MD 21208 |
Second Address | Baltimore, MD 21208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 16/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
144481600 | (05) | MD |
F36313 | (02) |