Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4175 | MD |
NPI | 1003209875 |
---|---|
Provider Name | Stanley Klein |
First Address | Baltimore, MD 21209 |
Second Address | Baltimore, MD 21209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2015 |
Last Update Date | 18/03/2015 |