Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | D0080347 | MD |
N | 208000000X | Pediatrician | MA07918100 | NJ |
N | 208D00000X | General Practice Physician | C10009764 | DE |
NPI | 1023008000 |
---|---|
Provider Name | Dr. Lisa Diane Urban |
First Address | Denton, MD 21629-1398 |
Second Address | Denton, MD 21629-1398 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 29/10/2020 |