Provider Demographics
NPI:1912193970
Name:OUTLAW, LAUREN GEVANA (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:GEVANA
Last Name:OUTLAW
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 1:6400 ARLINGTON BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2325
Mailing Address - Country:US
Mailing Address - Phone:571-425-4100
Mailing Address - Fax:571-254-4300
Practice Address - Street 1:6400 ARLINGTON BLVD STE 510
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2325
Practice Address - Country:US
Practice Address - Phone:571-425-4100
Practice Address - Fax:571-425-4300
Is Sole Proprietor?:No
Enumeration Date:2007-09-23
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD90375207V00000X
DCMD048786207VB0002X
VA0101257441207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200898630 FWOMedicaid
IN000000675480OtherANTHEM IN - FWO
IN000000675487OtherANTHEM IN - BMA
IN000000873394OtherBCBS
IN200898630Medicaid
IN01064686AOtherPHYSICIAN LICENSE
IN000000873394OtherBCBS
IN01064686AOtherPHYSICIAN LICENSE
IN000000675487OtherANTHEM IN - BMA