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>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1912999566

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 434-767-4822  Fax: 434-767-2211

Contact information for business:
Tel: 304-536-5030  Fax: 304-536-5051

Registration Information:
NPI: 1912999566
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine

Legacy codes, insurance codes and state license numbers:



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