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General NPI Number Information
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NPI Number | 1396068672
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Entity Type | Individual
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Provider Name | VADIM DUSHKIN
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Gender | Male
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 3 RIVERSIDE CIR
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City | ROANOKE
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State | VA
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Zip | 24016-4955
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Country | US
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Telephone | 540-224-5170
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Fax |
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Provider Business Mailing Address
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Address Line | 123 WINTHROP RD
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City | EDISON
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State | NJ
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Zip | 08817-3830
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Country | US
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Telephone | 718-541-2890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0101272125
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License Number State | VA
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