Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101043687 | VA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 0101043687 | VA |
NPI | 1346290798 |
---|---|
Provider Name | Craig S. Derkay |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 07/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010165601 | (05) | VA |
132251600 | (05) | MD |
890504N | (05) | NC |
E07632 | (02) |