Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | C0006647 | MD |
NPI | 1205347994 |
---|---|
Provider Name | Alina Gerasymova |
First Address | Rockville, MD 20850-5828 |
Second Address | Ellicott City, MD 21042-7703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2017 |
Last Update Date | 20/10/2017 |