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General NPI Number Information
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NPI Number | 1659303188
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Entity Type | Individual
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Provider Name | ALI IRANMANESH
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1970 ROANOKE BLVD R & D OFFICE (151)
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City | SALEM
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State | VA
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Zip | 24153-6404
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Country | US
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Telephone | 540-982-2463
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Fax |
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Provider Business Mailing Address
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Address Line | 1970 ROANOKE BLVD R & D OFFICE (151)
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City | SALEM
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State | VA
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Zip | 24153-6404
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Country | US
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Telephone |
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 0101030521
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License Number State | VA
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