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DR. COZUMEL SOUTHERN PRUETTE MD, MHS

Physicians Pediatrics Pediatric Nephrology

Provider NPI: 1295887750

Provider Information:
DR. COZUMEL SOUTHERN PRUETTE MD, MHS
Gender: F
Not Sole Proprietor

Practice Location:
200 N WOLFE ST ROOM 3055 BALTIMORE, MD 21287-0011 US
Tel: 410-955-2467  Fax: --

Business Mailing Address:
PO BOX 64316  BALTIMORE, MD 21264-4316 US
Tel: 410-955-4427  Fax: --

NPI Information:
NPI: 1295887750
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2080P0210XPhysicians
Pediatrics
Pediatric Nephrology
MDD67656
N208000000XPhysicians
Pediatrics
MDP20254

Other Provider Identifiers:

IssuerNumberStateType
055174100MD05



American Medical Association 2012 taxonomy code information

Code: 2080P0210X

Type:

Classification:



Definition:



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