Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0101246809 | VA |
N | 207V00000X | Obstetrician & Gynecologist | 36096 | AZ |
Y | 207VX0000X | Obstetrician | 0101246809 | VA |
NPI | 1174685994 |
---|---|
Provider Name | Rolel Mbaidjol-Kabra |
First Address | Falls Church, VA 22042-3307 |
Second Address | Falls Church, VA 22042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36096 | STATE LICENSE (01) | AZ |
FM0018451 | DEA (01) |