Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D69786 | MD |
Y | 111NI0900X | Internist | D69786 | MD |
N | 208000000X | Pediatrician | D69786 | MD |
NPI | 1003277468 |
---|---|
Provider Name | Wendie Katrina Grader-Beck |
First Address | Reisterstown, MD 21136-1125 |
Second Address | Reisterstown, MD 21136-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2016 |
Last Update Date | 14/03/2016 |