Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0101259242 | VA |
NPI | 1073518452 |
---|---|
Provider Name | Mikhail Vinogradov |
First Address | Charlottesville, VA 22911-3645 |
Second Address | Charlottesville, VA 22911-3645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I10777 | (02) |