Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | D46191 | MD |
Y | 207VE0102X | Reproductive Endocrinologist | D46191 | MD |
NPI | 1497789853 |
---|---|
Provider Name | Mr. Laurence C Udoff |
First Address | Fairfax, VA 22031-4623 |
Second Address | Fairfax, VA 22031-4623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 30/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150951900 | (05) | MD |
F91242 | (02) | MD |