Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101258083 | VA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2010017826 | MO |
NPI | 1013238021 |
---|---|
Provider Name | Dr. Sarah Blank |
First Address | Falls Church, VA 22042-1204 |
Second Address | Falls Church, VA 22042-1204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2010 |
Last Update Date | 17/06/2015 |