Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | D69441 | MD |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | D69441 | MD |
NPI | 1174755490 |
---|---|
Provider Name | Sepideh Sadr Dadras |
First Address | Columbia, MD 21045-5841 |
Second Address | Columbia, MD 21045-5841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 19/11/2012 |