Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101042245 | VA |
NPI | 1144280652 |
---|---|
Provider Name | Dr. Bonita J Makdad |
First Address | Richmond, VA 23226-2659 |
Second Address | Richmond, VA 23226-2659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06707432 | (05) | VA |