Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | S03982 | MD |
NPI | 1316425762 |
---|---|
Provider Name | Sofia Tedesco |
First Address | Gaithersburg, MD 20878-6549 |
Second Address | Rockville, MD 20850-3947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2018 |
Last Update Date | 29/07/2018 |