Individual
DR. LARA MAMIKONIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 CHILDREN'S LANE, CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, NORFOLK, VA 23502
(585) 905-9377
Mailing address
601 CHILDREN'S LANE, CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, NORFOLK, VA 23502
(585) 905-9377
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0101251975
VA
208000000X
Pediatrics Physician
2009-00675
NC
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
0101251975
VA
Other
Enumeration date
08/01/2006
Last updated
10/28/2019
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