Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD0000027717 | TN |
NPI | 1013018431 |
---|---|
Provider Name | Dr. Christopher A Pendola |
First Address | Kingsport, TN 37660-5894 |
Second Address | Kingsport, TN 37660-5894 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 09/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1526971 | (05) | TN |
G34586 | (02) | TN |