Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 0101026570 | VA |
NPI | 1013921972 |
---|---|
Provider Name | Dr. Joseph G Servideo |
First Address | Chantilly, VA 20153-3323 |
Second Address | Warrenton, VA 20186-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010055555 | (05) | VA |
6019951 | (05) | VA |
B08757 | (02) |