| NPI | 1255791976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL DOUGLAS LORD Owner 301-502-5566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 207VG0400X Obstetrics & Gynecology, Gynecology | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2018-06-11 |