Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101048592 | VA |
Y | 2080P0210X | Pediatric Nephrologist | 0101048592 | VA |
NPI | 1508812702 |
---|---|
Provider Name | Irene G. Restaino |
First Address | Baltimore, MD 21279-0137 |
Second Address | Norfolk, VA 23507-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 20/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012193300005 | (05) | PA |
006721966 | (05) | VA |
698091100 | (05) | MD |
9840886000 | (05) | WV |
E75927 | (02) |