Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0101263173 | VA |
NPI | 1033499116 |
---|---|
Provider Name | Riccardo Autorino |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-5054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2011 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0107147 | (05) | OH |