Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 0101265085 | VA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 35.121670 | OH |
NPI | 1740486018 |
---|---|
Provider Name | Laura E.a Gill Sealy |
First Address | Fairfax, VA 22031-2241 |
Second Address | Fairfax, VA 22031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 16/07/2018 |