Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 0101048487 | VA |
NPI | 1053316034 |
---|---|
Provider Name | Edward Stephen Buescher |
First Address | Virginia Beach, VA 23452-3839 |
Second Address | Norfolk, VA 23510-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6753841 | VIRGINIA PROVIDER # (01) | VA |