An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Medical Specialty | 261QM2500X |
* Indicates primary specialty
| NPI Number | 1457828725 |
| Credentials | MD |
| Entity | Individual |
| Enumeration date | 10/25/2018 |
| Last updated | 10/25/2018 - About 8 years ago |
| Sole proprietor1 | Yes |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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