Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 02001653 | IN |
Y | 2081S0010X | Sports Medicine | 0102049882 | VA |
Y | 213ES0000X | Sports Medicine | 0102049882 | VA |
NPI | 1063464451 |
---|---|
Provider Name | Dr. Andrea Rose Conti |
First Address | Roanoke, VA 24014-1111 |
Second Address | Roanoke, VA 24014-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 10/12/2020 |