Do you possess a degree in medicine from an accredited college or university?
Yes
No
2
Are you currently licensed to practice medicine by the Maryland Board of Physicians? (If Yes, please submit a copy of your license or license verification with your application.)
Yes
No
3
If yes, please provide your license type, license number and expiration date below.
4
Do you currently possess a certification by an American Medical Association Specialty Board in Psychiatry? (If Yes, please submit a copy of your certification with your application.)