Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0103300797 | VA |
NPI | 1114964582 |
---|---|
Provider Name | Dr. Grace M Lents |
First Address | Fairfax, VA 22031-2715 |
Second Address | Bethesda, MD 20889-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 08/07/2007 |