Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35085788M | OH |
N | 111NI0900X | Internist | 35085788M | OH |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 0101256847 | VA |
N | 207RC0000X | Internist - Cardiovascular Disease | 0101256847 | VA |
NPI | 1023000809 |
---|---|
Provider Name | Sula Mazimba |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2569377 | (05) | OH |
I34583 | (02) | OH |