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:
Health care specialties
Specialty | Code | License # | 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
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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