Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 97-01847 | NC |
NPI | 1306805841 |
---|---|
Provider Name | Enrico E Piva |
First Address | Winston Salem, NC 27103-3044 |
Second Address | Winston Salem, NC 27103-6946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 16/04/2013 |