Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA08889500 | NJ |
N | 208600000X | Surgeon | 25MA08889500 | NJ |
N | 208200000X | Surgeon | MD449191 | PA |
N | 208600000X | Surgeon | MD449191 | PA |
Y | 2086S0129X | Vascular Surgeon | 0101266345 | VA |
NPI | 1104117092 |
---|---|
Provider Name | Dr. Tal S Bash |
First Address | Virginia Beach, VA 23462-6565 |
Second Address | Virginia Beach, VA 23462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 29/04/2019 |