Individual
DWIGHT D IM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
227 ST. PAUL PLACE, 6TH FLOOR, BALTIMORE, MD 21202-2102
(410) 332-9002
(410) 783-5880
Mailing address
301 SAINT PAUL PL, MEDICAL STAFF OFFICE, BALTIMORE, MD 21202-2102
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
D0043934
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
447571200
—
MD
01
—
KT93ST / 528170-06
BC / BS OF MD
MD
01
—
S186 / 0013
BLUECHOICE
MD
Enumeration date
06/04/2006
Last updated
03/26/2014
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