Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 0101045582 | VA |
NPI | 1245204353 |
---|---|
Provider Name | Dr. Thomas Joel Hougen |
First Address | Potomac, MD 20854-1201 |
Second Address | Arlington, VA 22205-3683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A54259 | (02) |