Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 237156 | MA |
N | 111NI0900X | Internist | 237156 | MA |
Y | 207RI0200X | Infectious Disease | D58251 | MD |
NPI | 1043264492 |
---|---|
Provider Name | Ms. Mettassebia Kanno |
First Address | Rockville, MD 20852-4908 |
Second Address | Baltimore, MD 21201-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 20/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043264492 | (05) | DE |
395000000 | (05) | MD |
617124-01 | BLUE CROSS/BLUE SHIELD (01) | MD |