Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 0101237969 | VA |
Y | 207RH0003X | Hematology & Oncology | 36826 | TN |
NPI | 1063489649 |
---|---|
Provider Name | Dr. Marco A Dasilva |
First Address | Kingsport, TN 37660-4632 |
Second Address | Kingsport, TN 37660-1050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 06/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010030714 | (05) | VA |
3879352 | (05) | TN |
D69429 | (02) |