Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A000056 | MD |
Y | 213ES0000X | Sports Medicine | A000056 | MD |
NPI | 1154723419 |
---|---|
Provider Name | Sarah Koehn |
First Address | Parkton, MD 21120-9135 |
Second Address | Parkton, MD 21120-9135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 18/09/2014 |