Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | M7412 | TX |
NPI | 1003877523 |
---|---|
Provider Name | Tiffany N Mccalla |
First Address | Baltimore, MD 21273-0001 |
Second Address | Baltimore, MD 21223-1558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 07/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
189741501 | (05) | TX |
408208700 | (05) | MD |
8AX740 | BCBS (01) | TX |
8U4003 | BCBS (01) | TX |
I38382 | (02) | TX |