Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 101048206 | VA |
NPI | 1689115768 |
---|---|
Provider Name | Mari Miyamoto Hayashi |
First Address | Mechanicsville, VA 23116-2309 |
Second Address | Mechanicsville, VA 23116-2309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2017 |
Last Update Date | 09/03/2017 |