Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | S01917 | MD |
NPI | 1003958547 |
---|---|
Provider Name | Robert Paul Marvenko |
First Address | Baltimore, MD 21244-3125 |
Second Address | Baltimore, MD 21244-3125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |