Healthcare Provider Details

I. General information

NPI: 1750401824
Provider Name (Legal Business Name): MAYA LODISH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR BUILDING 10-CRC ROOM 1-3330
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

10 CENTER DR BUILDING 10-CRC ROOM 1-3330
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-451-0396
  • Fax:
Mailing address:
  • Phone: 301-451-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberD0063958
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: