Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101267144 | VA |
NPI | 1053708685 |
---|---|
Provider Name | Joshua Eikenberg |
First Address | Roanoke, VA 24014-1838 |
Second Address | Roanoke, VA 24014-1838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 11/12/2020 |