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General NPI Number Information
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NPI Number | 1952398950
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Entity Type | Individual
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Provider Name | LARA L DIMICK-SANTOS MD
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Gender | Female
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 2001 MEDICAL PKWY
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3280
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Country | US
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Telephone | 443-481-1000
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Fax | 443-481-1360
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Provider Business Mailing Address
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Address Line | PO BOX 64834
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City | BALTIMORE
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State | MD
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Zip | 21264-4834
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Country | US
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Telephone | 443-481-6580
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Fax | 443-481-6515
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D0063559
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License Number State | MD
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