Healthcare Provider Details

I. General information

NPI: 1962862672
Provider Name (Legal Business Name): FAME ALLERGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 APPERSON DR
SALEM VA
24153-7133
US

IV. Provider business mailing address

1002 APPERSON DR
SALEM VA
24153-7133
US

V. Phone/Fax

Practice location:
  • Phone: 540-521-6414
  • Fax:
Mailing address:
  • Phone: 540-521-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: THOMAS M FAME
Title or Position: OWNER
Credential: MD
Phone: 540-521-6414