Individual
DR. LARA L DIMICK-SANTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 MEDICAL PKWY, ANNAPOLIS, MD 21401-3280
(443) 481-1000
(443) 481-1360
Mailing address
PO BOX 64834, BALTIMORE, MD 21264-4834
(443) 481-6580
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
D0063559
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145724700
FEDERAL WORKMEN'S COMP
MD
01
—
887BAA 6474901
CAREFIRST MARYLAND
—
05
—
936200201 408805100
—
MD
01
—
K5880004
CAREFIRST DC
—
Enumeration date
10/04/2005
Last updated
02/25/2009
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