Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MTL001777 | DC |
NPI | 1013351436 |
---|---|
Provider Name | Lauren Mckelroy |
First Address | Jackson, MS 39216-4500 |
Second Address | Washington, DC 20037-1873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 21/01/2020 |