Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0101237445 | VA |
NPI | 1356315840 |
---|---|
Provider Name | Dr. Laura M Gesicki-Wood |
First Address | Springfield, VA 22152-1800 |
Second Address | Springfield, VA 22152-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10191734 | (05) | VA |
I47384 | (02) | VA |