Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0101266690 | VA |
Y | 207PP0204X | Pediatric Emergency Physician | 0101266690 | VA |
NPI | 1619331477 |
---|---|
Provider Name | Laila Anna Moraczewski |
First Address | Richmond, VA 23226-1922 |
Second Address | Richmond, VA 23226-1922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 08/07/2021 |