Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101050120 | VA |
NPI | 1013062926 |
---|---|
Provider Name | Dr. Lisa A Pauls |
First Address | Rockville, MD 20852 |
Second Address | Woodbridge, VA 22192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F88333 | (02) |