Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | D64567 | MD |
NPI | 1003853961 |
---|---|
Provider Name | Sara A Divall |
First Address | Baltimore, MD 21264-4316 |
Second Address | Baltimore, MD 21287-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 22/01/2014 |