Healthcare Provider Details

I. General information

NPI: 1578982625
Provider Name (Legal Business Name): LINDSAY RUSSOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY MAKARA

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20925 PROFESSIONAL PLZ STE 100
ASHBURN VA
20147-3403
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-8900
  • Fax: 703-723-8400
Mailing address:
  • Phone: 202-476-3670
  • Fax: 202-476-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101261761
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: