Individual
ETHAN SOUDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2416 FOREST GREEN CT, BALTIMORE, MD 21209-1566
(443) 352-8992
Mailing address
2416 FOREST GREEN CT, BALTIMORE, MD 21209-1566
(443) 352-8992
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
127459
ZZ
Other
Enumeration date
03/17/2011
Last updated
03/17/2011
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