Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | D46950 | MD |
N | 2080P0216X | Pediatric Rheumatologist | MD035811 | DC |
NPI | 1669566691 |
---|---|
Provider Name | Lisa Rider |
First Address | Bethesda, MD 20892-0001 |
Second Address | Bethesda, MD 20892-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 03/04/2009 |