Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0101251459 | VA |
Y | 208600000X | Surgeon | 0101251459 | VA |
N | 2086X0206X | Surgical Oncologist | 231941 | NY |
NPI | 1245512565 |
---|---|
Provider Name | Dr. Itzhak Avital |
First Address | Richmond, VA 23226-1934 |
Second Address | Richmond, VA 23226-1934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2011 |
Last Update Date | 19/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C06695 | GROUP PTAN (01) | VA |
C06778 | GROUP PTAN (01) | VA |