Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 22109 | WV |
NPI | 1013116912 |
---|---|
Provider Name | Dr. Shayna B. Tomchin |
First Address | Portsmouth, OH 45662-2681 |
Second Address | Portsmouth, OH 45662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0285110 | (05) | OH |