| NPI | 1407357015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE NEVADA JOHNSON Credentialing Coordinator 540-536-0103 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| 207T00000X Neurological Surgery | |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 208800000X Urology | |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2018-03-17 |