Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 224668 | NY |
NPI | 1225100126 |
---|---|
Provider Name | Dr. Tatiana A Pavlova Greenfield |
First Address | Rockville, MD 20852 |
Second Address | Rockville, MD 20852-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |