Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101022994 | VA |
N | 207N00000X | Dermatologist | 200301017 | NC |
N | 207ND0101X | MOHS-Micrographic Surgeon | 0101022994 | VA |
NPI | 1164533386 |
---|---|
Provider Name | Padman A Menon |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Virginia Beach, VA 23454-2432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010109868 | (05) | VA |
013XM | NC GRP # BCBS (01) | NC |
135YU | INDIVIDUAL NC BCBS (01) | NC |
2003292 | NC MEDICARE GRP # (01) | NC |
89013XM | (05) | NC |
89135YU | (05) | NC |
C04588 | MEDICARE GROUP NUMBER (01) | VA |