Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101236847 | VA |
NPI | 1023089992 |
---|---|
Provider Name | Dr. Marco Antonio Ayala |
First Address | Portsmouth, VA 23708-2111 |
Second Address | Portsmouth, VA 23708-2111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 06/02/2020 |