Individual
GHISLAINE LAISSA OUEDRAOGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. D.
Contact information
Practice address
12 N THOMPSON ST, RICHMOND, VA 23221-2718
(804) 359-9861
Mailing address
PO BOX 758963, BALTIMORE, MD 21275-8963
(804) 822-4355
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101239861
VA
Other
Enumeration date
08/20/2006
Last updated
11/06/2007
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