Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 0101245981 | VA |
NPI | 1205082039 |
---|---|
Provider Name | Dr. Lara Elizabeth Pawlow Quinlan |
First Address | Newport News, VA 23606-4430 |
Second Address | Newport News, VA 23606-4430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 19/03/2013 |