Individual
LARRY KEITH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2336 GODDARD PKWY, SALISBURY, MD 21801-1126
(410) 334-6961
(410) 334-6362
Mailing address
2336 GODDARD PKWY, SALISBURY, MD 21801-1126
(410) 334-6961
(410) 334-6362
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D0051458
MD
2084P0800X
Psychiatry Physician
MD26174
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225016561
GROUP NPI #
OR
05
—
609550001
—
MD
05
—
609550002
—
MD
05
—
609550004
—
MD
01
—
930593249
GROUP TAX ID #
OR
01
—
LM49EA
CAREFIRST BCBS LOCAL
MD
01
—
R968
CAREFIRST BCBS
MD
Enumeration date
02/23/2007
Last updated
04/28/2011
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