Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 00037326 | MD |
Y | 207RG0100X | Gastroenterologist | 0101051491 | VA |
NPI | 1043318942 |
---|---|
Provider Name | Ann I Ma |
First Address | Leesburg, VA 20176-2700 |
Second Address | Leesburg, VA 20176-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 03/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203435 | ANTHEM BCBS (01) | VA |
247336 | UNITED HEALTHCARE MAMSI (01) | |
F07586 | (02) |