Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DR.0058777 | CO |
NPI | 1770584344 |
---|---|
Provider Name | Richard Wertheimer |
First Address | Chesapeake, VA 23320-4985 |
Second Address | Chesapeake, VA 23320-4985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 11/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7110294 | (05) | VA |
B05859 | (02) |