Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME117758 | FL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 0101236348 | VA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD034954 | DC |
NPI | 1831289206 |
---|---|
Provider Name | Laurel Claire Blakemore |
First Address | Fairfax, VA 22031-2240 |
Second Address | Fairfax, VA 22031-2240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009880000 | (05) | FL |
F78374 | (02) |