Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | D56140 | MD |
N | 204C00000X | Sports Medicine Doctor | VA0101225846 | VA |
Y | 2081P2900X | Pain Medicine | D56140 | MD |
N | 2081P2900X | Pain Medicine | VA0101225846 | VA |
N | 2081S0010X | Sports Medicine | D56140 | MD |
N | 213ES0000X | Sports Medicine | D56140 | MD |
N | 2081S0010X | Sports Medicine | VA0101225846 | VA |
N | 213ES0000X | Sports Medicine | VA0101225846 | VA |
NPI | 1851376651 |
---|---|
Provider Name | Joan Luo |
First Address | Gaithersburg, MD 20877-1308 |
Second Address | Gaithersburg, MD 20877-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 04/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010101743 | (05) | VA |
432320300 | (05) | MD |
H31687 | (02) | MD |