Provider Demographics
NPI:1841406147
Name:FIELD, LARAINE TERRY (MD)
Entity Type:Individual
Prefix:
First Name:LARAINE
Middle Name:TERRY
Last Name:FIELD
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 1:6412 BEULAH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2671
Mailing Address - Country:US
Mailing Address - Phone:703-922-6161
Mailing Address - Fax:703-922-1899
Practice Address - Street 1:6412 BEULAH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2671
Practice Address - Country:US
Practice Address - Phone:703-922-6161
Practice Address - Fax:703-922-1899
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE13407Medicare UPIN