Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 18951 | NV |
Y | 111NI0900X | Internist | 18951 | NV |
NPI | 1003103953 |
---|---|
Provider Name | Chanukya Rama Dahagam |
First Address | Las Vegas, NV 89102-2312 |
Second Address | Las Vegas, NV 89102-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 17/04/2020 |