Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0401412702 | VA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0401412702 | VA |
NPI | 1326065939 |
---|---|
Provider Name | Mitchell J Magid |
First Address | Lynchburg, VA 24502-4329 |
Second Address | Lynchburg, VA 24502-4329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 15/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T93005 | (02) |