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General NPI Number Information
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NPI Number | 1063467082
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Entity Type | Organization
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Legal Business Name | ODDYSSEY IV, LLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 2923 FRANKLIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24014-1001
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Country | US
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Telephone | 540-563-9840
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Fax | 540-851-0881
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Provider Business Mailing Address
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Address Line | PO BOX 12746
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City | ROANOKE
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State | VA
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Zip | 24028-2746
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Country | US
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Telephone | 540-563-9840
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Fax | 540-581-0881
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Authorized Official
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Title or Position | PRESIDENT
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Name | NAIYER IMAM
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Credential | M. D.
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Telephone | 540-563-9840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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