Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 0101245001 | VA |
NPI | 1780874917 |
---|---|
Provider Name | Brian M. Trotta |
First Address | Myrtle Beach, SC 29578-3099 |
Second Address | New Bern, NC 28562-5238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 22/11/2013 |