Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 010245177 | VA |
NPI | 1104011766 |
---|---|
Provider Name | Dr. Adegbenga A. Bankole |
First Address | Roanoke, VA 24016 |
Second Address | Roanoke, VA 24016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2007 |
Last Update Date | 11/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810014657 | (05) | WV |
540506332004 | TRICARE (01) | VA |