Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | D57871 | MD |
N | 207R00000X | Internist | D57871 | MD |
N | 111NI0900X | Internist | D57871 | MD |
NPI | 1134173594 |
---|---|
Provider Name | Yngvild Olsen |
First Address | Baltimore, MD 21218-5612 |
Second Address | Baltimore, MD 21218-5612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 25/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
699117300 | (05) | MD |
H42756 | (02) | MD |