Provider Demographics
NPI:1346407855
Name:PARDO LAMEDA, IVANESA LAURA (MD)
Entity Type:Individual
Prefix:
First Name:IVANESA
Middle Name:LAURA
Last Name:PARDO LAMEDA
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 1:106 IRVING ST NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-877-7788
Mailing Address - Fax:877-680-8198
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 301
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-7788
Practice Address - Fax:877-680-8198
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD044591208600000X
IN11013477A390200000X
NY004111390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program