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Physicians Psychiatry & Neurology Neurology

Provider NPI: 1003896762

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 434-654-8960  Fax: 434-654-8962

Business Mailing Address:
PO BOX 79777  BALTIMORE, MD 21279-0777 US
Tel: 434-654-7794  Fax: 434-654-8962

NPI Information:
NPI: 1003896762
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Psychiatry & Neurology

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 2084N0400X





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