Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 0101229313 | VA |
NPI | 1417937269 |
---|---|
Provider Name | Eugenie E Charles |
First Address | Leesburg, VA 20176-5101 |
Second Address | Leesburg, VA 20176-5101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H67898 | (02) |