Individual
LINDSAY ILENE DIBASTIANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5 GARRETT AVE, LA PLATA, MD 20646-5960
(301) 609-4000
Mailing address
5 GARRETT AVE, LA PLATA, MD 20646-5960
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0009083
MD
363AM0700X
Medical Physician Assistant
C0009083
MD
Other
Enumeration date
09/25/2023
Last updated
06/28/2024
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