Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 0116015082 | VA |
NPI | 1023185394 |
---|---|
Provider Name | Tamer Ghanem |
First Address | Charlottesville, VA 22901-1681 |
Second Address | Charlottesville, VA 22908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |