Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101259297 | VA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 0101259297 | VA |
NPI | 1720490683 |
---|---|
Provider Name | Dr. Vincent John Nardone |
First Address | Gloucester, VA 23061-4178 |
Second Address | Richmond, VA 23225-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 31/01/2022 |