Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD13443 | RI |
NPI | 1477715811 |
---|---|
Provider Name | Dr. Christopher S Mudge |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 16/01/2018 |