Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1976 | MD |
NPI | 1083616361 |
---|---|
Provider Name | Dr. Jewa Maria Lea |
First Address | Laurel, MD 20708-2508 |
Second Address | Burtonsville, MD 20866-1172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 08/07/2007 |