Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D39934 | MD |
N | 207QA0401X | Family Doctor - Addiction Medicine | D39934 | MD |
N | 207QG0300X | Family Doctor - Geriatric Medicine | D39934 | MD |
NPI | 1447657911 |
---|---|
Provider Name | Steven Coulter |
First Address | Columbia, MD 21045-4216 |
Second Address | Columbia, MD 21045-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2014 |
Last Update Date | 29/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E22115 | (02) | MD |