Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101263166 | VA |
NPI | 1003260407 |
---|---|
Provider Name | Dr. Elnaz Balakhanlou |
First Address | Gaithersburg, MD 20878-1469 |
Second Address | Gaithersburg, MD 20878-1469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2016 |
Last Update Date | 26/06/2020 |