Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | D20775 | MD |
NPI | 1003843657 |
---|---|
Provider Name | Robert Wise |
First Address | Middle River, MD 21220-2004 |
Second Address | Baltimore, MD 21287-0006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 27/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
786541400 | (05) | MD |
D77826 | (02) | MD |