Wise, Larry Keith

Wise, Larry Keith is an individual health care provider with primary practice located at 2336 Goddard Pkwy , Salisbury MD 21801-1126. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Wise, Larry Keith can be contacted via phone (410) 334-6961.

Contact Information

Primary practice address
2336 Goddard Pkwy Salisbury MD 21801-1126
Phone: (410) 334-6961
Fax: (410) 334-6362
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X MD26174 Oregon
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X D0051458 Maryland

Profile Details

NPI number 1407982721
LBN Legal business name Wise, Larry Keith
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 23rd, 2007
Last updated Apr 28th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407982721 NPPES
Oregon Other 930593249 GROUP TAX ID #
Oregon MEDICAID 609550001 GROUP TAX ID #
Oregon MEDICAID 609550002 GROUP TAX ID #
Oregon Other 1225016561 GROUP TAX ID #
Oregon MEDICAID 609550004 GROUP TAX ID #
Oregon Other LM49EA GROUP TAX ID #
Oregon Other R968 GROUP TAX ID #

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