Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | D0011648 | MD |
NPI | 1043513658 |
---|---|
Provider Name | Nevins Woodcock Todd JR. |
First Address | Salisbury, MD 21804 |
Second Address | Salisbury, MD 21801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2010 |
Last Update Date | 21/12/2010 |