Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 0101030626 | VA |
NPI | 1265493365 |
---|---|
Provider Name | Robert C Radin |
First Address | Virginia Beach, VA 23464-3111 |
Second Address | Virginia Beach, VA 23452-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 05/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006037500 | (05) | VA |
B08905 | (02) | VA |