Healthcare Provider Details

I. General information

NPI: 1801010491
Provider Name (Legal Business Name): CYNTHIA LAUTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19522 DOCTORS DR
GERMANTOWN MD
20874-5200
US

IV. Provider business mailing address

19522 DOCTORS DR
GERMANTOWN MD
20874-5200
US

V. Phone/Fax

Practice location:
  • Phone: 301-540-5900
  • Fax:
Mailing address:
  • Phone: 301-540-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number65254
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number241682
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: