Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 13234 | MD |
N | 1223D0001X | Dental Public Health | 13234 | MD |
NPI | 1194769349 |
---|---|
Provider Name | Patrice Mcleod |
First Address | Frederick, MD 21702-4397 |
Second Address | Frederick, MD 21702-4397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 17/11/2009 |