Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 2021-02017 | NC |
N | 207RG0100X | Gastroenterologist | 282536 | NY |
NPI | 1023317260 |
---|---|
Provider Name | Laila Menon |
First Address | Statesville, NC 28687-1845 |
Second Address | Mooresville, NC 28117-8540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2011 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04800208 | (05) | NY |