Provider Demographics
NPI:1023034709
Name:AZER, LJUBICA (MD)
Entity Type:Individual
Prefix:
First Name:LJUBICA
Middle Name:
Last Name:AZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4158 DALE BLVD
Mailing Address - Street 2:
Mailing Address - City:DALE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22193
Mailing Address - Country:US
Mailing Address - Phone:703-680-5959
Mailing Address - Fax:703-730-1046
Practice Address - Street 1:4158 DALE BLVD
Practice Address - Street 2:
Practice Address - City:DALE CITY
Practice Address - State:VA
Practice Address - Zip Code:22193-2225
Practice Address - Country:US
Practice Address - Phone:703-680-5959
Practice Address - Fax:703-730-1046
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027027173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine