Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 19989 | OK |
Y | 207R00000X | Internist | 19989 | OK |
Y | 111NI0900X | Internist | 19989 | OK |
NPI | 1104280114 |
---|---|
Provider Name | Zeno Lancelot Charles-Marcel |
First Address | Silver Spring, MD 20904-6601 |
Second Address | Silver Spring, MD 20904-6601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 06/04/2016 |