| Name | Value |
|---|---|
| PROVIDER TYPE | Allopathic & Osteopathic Physicians |
| CLASSIFICATION | Pediatrics |
| DEFINITION | A pediatrician who specializes in clinical and laboratory immunology disease management. |
| AREA OF SPECIALIZATION | Clinical & Laboratory Immunology |
| STATUS | Active |
| VA CODE | V182502 |
| X12 CODE | 2080I0007X |
| SPECIALTY CODE | 37 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5251853 |
| EFFECTIVE DATE/TIME |
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