Individual
DR. ALVIN J DETTERLINE IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8322 BELLONA AVE, SUITE 100, TOWSON, MD 21204-2065
(410) 337-7900
(410) 821-1334
Mailing address
8322 BELLONA AVE, SUITE 100, TOWSON, MD 21204-2065
(410) 337-7900
(410) 821-1334
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
35-088976
OH
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
D0067412
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0067412
MARYLAND BOP LICENSE
—
Enumeration date
01/26/2007
Last updated
11/13/2013
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