Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 0101226895 | VA |
NPI | 1306894910 |
---|---|
Provider Name | Dr. Michael J Devine |
First Address | Charlottesville, VA 22911-3569 |
Second Address | Charlottesville, VA 22911-3569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 13/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G99954 | (02) | VA |