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General NPI Number Information
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NPI Number | 1770819294
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Entity Type | Individual
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Provider Name | MIRAM KHAN AFRIDI M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 3700 S MAIN ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-7017
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Country | US
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Telephone | 540-951-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 4504 STARKEY RD, STE 200
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City | ROANOKE
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State | VA
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Zip | 24018-6061
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Country | US
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Telephone | 540-725-8281
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101252632
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License Number State | VA
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