Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 0101221449 | VA |
NPI | 1073574612 |
---|---|
Provider Name | Dr. David E. Sisson |
First Address | Winchester, VA 22601 |
Second Address | Winchester, VA 22601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 04/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073574612 | (05) | VA |
298306 | BLUE CROSS OF VIRGINIA (01) | VA |
6000048000 | (05) | WV |
G97972 | (02) |