Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 0101043951 | VA |
NPI | 1003919580 |
---|---|
Provider Name | Barry Burureser Mcconville |
First Address | Laurel, MD 20725-0639 |
Second Address | Fairfax, VA 22030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006 | BCBS (01) | DC |
010250170 | (05) | VA |
189533 | ANTHEM (01) | VA |
9105 | BCBS (01) | DC |