Healthcare Provider Details

I. General information

NPI: 1699873760
Provider Name (Legal Business Name): RENE NERI VAMENTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 S MAIN ST
ROCKY MOUNT VA
24151-1750
US

IV. Provider business mailing address

681 S MAIN ST
ROCKY MOUNT VA
24151-1750
US

V. Phone/Fax

Practice location:
  • Phone: 540-483-2849
  • Fax: 540-483-2826
Mailing address:
  • Phone: 540-483-2849
  • Fax: 540-483-2826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101049828
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: