Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 0101056086 | VA |
NPI | 1447367057 |
---|---|
Provider Name | Dr. Christopher Wade Pile |
First Address | Roanoke, VA 24018-0613 |
Second Address | Roanoke, VA 24018-0613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 12/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015612C19 | TRAILBLAZER MEDICARE (01) | VA |
1447367057 | (05) | VA |
G94323 | (02) |