Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 0101058695 | VA |
NPI | 1023004710 |
---|---|
Provider Name | Souheil Ghandour Abou Assi |
First Address | Richmond, VA 23230-2918 |
Second Address | Richmond, VA 23230-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1100088459 | (05) | VA |
H63352 | (02) |