Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0101249276 | VA |
N | 207KA0200X | Allergist | 29320 | AZ |
NPI | 1548340748 |
---|---|
Provider Name | Dr. Laura Ispas |
First Address | Leesburg, VA 20176-8102 |
Second Address | Leesburg, VA 20176-8102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 03/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H46174 | (02) | AZ |