Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101028013 | VA |
N | 111NI0900X | Internist | 0101028013 | VA |
Y | 207RA0401X | Internist - Addiction Medicine | 0101028013 | VA |
N | 207VG0400X | Gynecologist | 0101028013 | VA |
NPI | 1720016389 |
---|---|
Provider Name | Rodolfo Cartagena |
First Address | Lebanon, VA 24266-0306 |
Second Address | Appalachia, VA 24216-1203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 04/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010255325 | (05) | VA |
1720016389 | (05) | VA |
B06159 | (02) |