Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101271502 | VA |
NPI | 1053844530 |
---|---|
Provider Name | Divya Angra |
First Address | Charlottesville, VA 22908-0816 |
Second Address | Charlottesville, VA 22908-0816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 30/04/2021 |