Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 0101032481 | VA |
NPI | 1023018140 |
---|---|
Provider Name | Amjad Uzair Wyne |
First Address | Christiansburg, VA 24073-6344 |
Second Address | Christiansburg, VA 24073-6344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 10/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010116473 | (05) | VA |
B05913 | (02) | VA |
CF9878 | RR MEDICARE GROUP (01) | VA |