Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 03823 | KY |
N | 111NI0900X | Internist | 03823 | KY |
N | 207RA0401X | Internist - Addiction Medicine | 03823 | KY |
NPI | 1720347214 |
---|---|
Provider Name | Edwin Avallone |
First Address | Lexington, KY 40536-0200 |
Second Address | Lexington, KY 40536-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 10/12/2018 |