Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0101018032 | VA |
NPI | 1073540779 |
---|---|
Provider Name | David Riddick |
First Address | Richmond, VA 23229-4614 |
Second Address | Richmond, VA 23229-4614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 05/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B06438 | (02) | VA |