Individual
TIN SEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2434 W BELVEDERE AVE, BALTIMORE, MD 21215-5267
(410) 601-2246
Mailing address
324 LIMESTONE VALLEY DR, APARTMENT # D, COCKEYSVILLE, MD 21030-4508
(410) 628-6066
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D65918
MD
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
D65918
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014526200
—
MD
Enumeration date
02/11/2007
Last updated
08/25/2009
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