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DHMH : cdssearch: M12830

CDSPERMIT

M12830

APPLICANT_NAME

A FREDERICK NORTH

APPLICANT_STATUS

NON RENEWED

CLASSIFICATION

PRACTITIONER

ADRESS

5705 OVERLEA ROAD

CITY

BETHESDA

COUNTY

 

ZIP

20891

STATE

MD

ADDRESS2

 

PROFESSION

MD

LICENSE_ISSUEDDATE

5/29/2008 12:00 AM

LICENSE_EXPDATE

10/31/2009 12:00 AM

CURR_CERTIFICATION

Y

Attachments

Created at 11/21/2013 11:55 AM by System Account
Last modified at 11/21/2013 11:55 AM by System Account