Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401415677 | VA |
Y | 213EG0000X | General Practice | 0401415677 | VA |
NPI | 1003346362 |
---|---|
Provider Name | Dr. Benjamin E Shapiro |
First Address | Roanoke, VA 24018-6439 |
Second Address | Roanoke, VA 24018-6439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2017 |
Last Update Date | 19/06/2017 |