| NPI | 1215269097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PADMAN A MENON President 757-825-1846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101022994) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 200301017) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2010-12-20 |