Individual
CASPER EZRA CLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 W 9TH ST, FREDERICK, MD 21701-4541
(301) 662-8119
(301) 696-0985
Mailing address
300 W 9TH ST, FREDERICK, MD 21701-4541
(301) 662-8119
(301) 696-0985
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D16428
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063493609
MEDICAID NPI
MD
01
—
110047911
MEDICARE RAILROAD
MD
05
—
252321300
—
MD
Enumeration date
11/10/2005
Last updated
05/12/2008
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