Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 040142795 | VA |
NPI | 1144315649 |
---|---|
Provider Name | Dr. Michael Joseph Mayerchak |
First Address | Roanoke, VA 24018-7788 |
Second Address | Roanoke, VA 24018-0614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 01/03/2013 |