Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A0001034 | MD |
Y | 213ES0000X | Sports Medicine | A0001034 | MD |
NPI | 1134758527 |
---|---|
Provider Name | Mechelle Suezette Norris |
First Address | Dale City, VA 22193 |
Second Address | Baltimore, MD 21210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2020 |
Last Update Date | 07/04/2020 |