Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 0101269656 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | D0089897 | MD |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD048435 | DC |
N | 207NS0135X | Procedural Dermatology | A161265 | CA |
NPI | 1437545498 |
---|---|
Provider Name | Annalise Oluwatoyin Abiodun |
First Address | Mc Lean, VA 22102-3109 |
Second Address | Mc Lean, VA 22102-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 04/06/2021 |