Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 14881 | NV |
N | 208000000X | Pediatrician | 0101235704 | VA |
Y | 2080P0204X | Pediatric Emergency Doctor | D76390 | MD |
NPI | 1164405866 |
---|---|
Provider Name | Dr. Anne Marie T Lagoc |
First Address | Baltimore, MD 21264-2063 |
Second Address | Baltimore, MD 21201-1513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 21/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010116520 | (05) | VA |
H79795 | (02) |