Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0101032804 | VA |
NPI | 1285678417 |
---|---|
Provider Name | Dr. Sudesh Tayal |
First Address | Radford, VA 24141-4210 |
Second Address | Radford, VA 24142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 08/07/2007 |