Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 20303 | NC |
NPI | 1013959527 |
---|---|
Provider Name | Roger Weed Lamanna |
First Address | Wilson, NC 27895-3127 |
Second Address | Wilson, NC 27893-4426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 11/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50628 | BLUE CROSS/BLUE SHIELD (01) | NC |
8950628 | (05) | NC |
C88731 | (02) | NC |