Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | H78106 | MD |
NPI | 1164713608 |
---|---|
Provider Name | Ms. Kelly Danielle Ryan |
First Address | Baltimore, MD 21237-3901 |
Second Address | Baltimore, MD 21237-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2011 |
Last Update Date | 11/08/2016 |