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General NPI Number Information
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NPI Number | 1063473551
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Entity Type | Individual
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Provider Name | ETOSHA D DIXON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2006
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 8800 WALTHER BLVD
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City | BALTIMORE
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State | MD
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Zip | 21234-9001
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Country | US
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Telephone | 410-882-3240
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Fax | 410-661-5093
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Provider Business Mailing Address
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Address Line | 5730 EXECUTIVE DR STE 230
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City | CATONSVILLE
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State | MD
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Zip | 21228-1762
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Country | US
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Telephone | 410-402-2379
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Fax | 410-463-3085
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 22045
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | D61785
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License Number State | MD
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