Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0101019015 | VA |
Y | 208600000X | Surgeon | 0101019015 | VA |
NPI | 1003802208 |
---|---|
Provider Name | Russell P. Seneca |
First Address | Fairfax, VA 22033-2917 |
Second Address | Fairfax, VA 22033-2917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7379056 | (05) | VA |
C61451 | (02) | VA |