Healthcare Provider Details

I. General information

NPI: 1003899014
Provider Name (Legal Business Name): CHRISTINE ROSE ERDIE-LALENA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

4 LERCHENSTRASSE
WALLHALBEN RHEINLAND PHALZ
66917
DE

V. Phone/Fax

Practice location:
  • Phone: 571-231-1177
  • Fax: 571-231-6631
Mailing address:
  • Phone: 011496375809545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number022850
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: