Healthcare Provider Details

I. General information

NPI: 1407837115
Provider Name (Legal Business Name): MARIA LIZA LINDENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARPENTER RD BLDG #525
FT MYER VA
22211-1009
US

IV. Provider business mailing address

4314 36TH ST NW
WASHINGTON DC
20008-4206
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-2977
  • Fax:
Mailing address:
  • Phone: 202-725-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD10157
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: