Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 3705 | SC |
NPI | 1063047033 |
---|---|
Provider Name | Victoria Pilgrim |
First Address | Greenville, SC 29607-6903 |
Second Address | Lynchburg, VA 24501-5616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2020 |
Last Update Date | 28/10/2020 |