Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 65967 | MD |
N | 2080P0203X | Pediatric Critical Care Doctor | 65967 | MD |
NPI | 1194708313 |
---|---|
Provider Name | Liliana Simon |
First Address | Rockville, MD 20854-2954 |
Second Address | Rockville, MD 20854-2954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 29/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H91217 | (02) |