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General NPI Number Information
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NPI Number | 1598958084
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Entity Type | Organization
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Legal Business Name | CYLBURN E SODEN M.D.P.A
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 13920 BALTIMORE AVE
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City | LAUREL
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State | MD
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Zip | 20707-5009
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Country | US
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Telephone | 301-776-1094
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Fax | 301-776-0456
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Provider Business Mailing Address
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Address Line | 13920 BALTIMORE AVE
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City | LAUREL
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State | MD
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Zip | 20707-5009
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Country | US
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Telephone | 301-776-1094
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Fax | 301-776-0456
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. VIRGINIA DORIS SODEN
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Credential | R.N.,M.S.
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Telephone | 301-776-1094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0024150
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License Number State | MD
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