Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 0110-006237 | VA |
NPI | 1124504949 |
---|---|
Provider Name | Chesney Blythe Carroll |
First Address | Fishersville, VA 22939-2333 |
Second Address | Fishersville, VA 22939-2333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2018 |
Last Update Date | 15/07/2018 |