Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 0101048225 | VA |
NPI | 1083691307 |
---|---|
Provider Name | Dr. Thomas Fame |
First Address | Roanoke, VA 24016-5206 |
Second Address | Salem, VA 24153-7312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 10/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010364141 | (05) | VA |
F27204 | (02) | |
P00276879 | MEDICARE RAILROAD (01) | VA |