Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | MT212190 | PA |
NPI | 1073964441 |
---|---|
Provider Name | Rebecca Suflas |
First Address | Baltimore, MD 21201-1644 |
Second Address | Baltimore, MD 21201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2016 |
Last Update Date | 27/06/2019 |