Basic Information
Provider Information
NPI: 1396981593
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMBROS
FirstName: VIRGINIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20410 CENTURY BLVD
Address2: NRH REGIONAL REHAB - #215
City: GERMANTOWN
State: MD
PostalCode: 208741186
CountryCode: US
TelephoneNumber: 3015406140
FaxNumber:  
Practice Location
Address1: 12 MEDSTAR BLVD
Address2:  
City: BEL AIR
State: MD
PostalCode: 210151798
CountryCode: US
TelephoneNumber: 4108778078
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/18/2008
LastUpdateDate: 03/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000XA1946MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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