Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101233988 | VA |
NPI | 1124017868 |
---|---|
Provider Name | Lee Berlad |
First Address | Fredericksburg, VA 22401-4467 |
Second Address | Fredericksburg, VA 22401-4467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2005 |
Last Update Date | 12/11/2010 |