Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 0101265616 | VA |
NPI | 1013362219 |
---|---|
Provider Name | Sean Mlodzinski |
First Address | Lynchburg, VA 24503-4915 |
Second Address | Lynchburg, VA 24501-1109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 29/06/2019 |