Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 14025 | MD |
NPI | 1114246071 |
---|---|
Provider Name | Roham Rafat |
First Address | Owings Mills, MD 21117-4203 |
Second Address | Owings Mills, MD 21117-4203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 10/10/2011 |