Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101251526 | VA |
NPI | 1003079807 |
---|---|
Provider Name | Laura Marie Kiszkiel |
First Address | Fulton, MD 20759-2694 |
Second Address | Fairfax, VA 22030-2877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 13/05/2021 |