Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 0101260539 | VA |
NPI | 1003154337 |
---|---|
Provider Name | Firas Kaddaha |
First Address | Farmville, VA 23901-1131 |
Second Address | Farmville, VA 23901-1131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2013 |
Last Update Date | 25/09/2019 |