Individual
DR. HI SUP SIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
251 LEWIS LANE, SUITE 201, HAVRE DE GRACE, MD 21078-3753
(410) 939-4477
(410) 939-1153
Mailing address
251 LEWIS LANE, SUITE 201, HAVRE DE GRACE, MD 21078-3753
(410) 939-4477
(410) 939-1153
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
D0046412
MD
207R00000X
Internal Medicine Physician
Primary
D0046412
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000424675
BS OF PA
PA
01
—
10199000000
PHN
MD
01
—
145388000
WCDL
MD
05
—
148241600
—
MD
01
—
52386701
BS OF MD
MD
01
—
W724002
BS OF DC
DC
01
—
W724002
DELMARVA HEALTH PLAN
MD
Enumeration date
05/09/2006
Last updated
02/02/2010
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