Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0401415195 | VA |
NPI | 1063711208 |
---|---|
Provider Name | Sarah Elizabeth Snow Summers |
First Address | Charlottesville, VA 22901-8124 |
Second Address | Charlottesville, VA 22901-8124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2011 |
Last Update Date | 18/09/2017 |