Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | D33679 | MD |
N | 207KA0200X | Allergist | D33679 | MH |
Y | 2080P0201X | Pediatric Allergist | D33679 | MD |
NPI | 1508894221 |
---|---|
Provider Name | Robert Wood |
First Address | Baltimore, MD 21264-4316 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 22/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
428921800 | (05) | MD |
D72211 | (02) | MD |