Doctor Name: | PEZHMAN SHOURESHI |
NPI Number: | 1093036105 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 0116022668 |
Business Practice Address: | 3700 S Main St Blacksburg, VA - 240607017 |
Business Phone Number: | 5409511111 |
Business Fax Number: | |
Mailing Address: | 3700 S Main St, BLACKSBURG |
State: | VA |
Postal Code: | 240607017 |
Phone Number: | 5409511111 |
Fax Number: | |
NPI Enumeration Date: | 06/13/2010 |
NPI Last Update Date: | 06/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0116022668 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |