Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101041220 | VA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 0101041220 | VA |
NPI | 1205878253 |
---|---|
Provider Name | Eric J. Werner |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 11/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017376580001 | (05) | PA |
006722016 | (05) | VA |
139491600 | (05) | MD |
890584J | (05) | NC |
B10384 | (02) |