Provider Demographics
NPI:1598848848
Name:HEAD ADN NECK MEDICINE AND SURGERY
Entity Type:Organization
Organization Name:HEAD ADN NECK MEDICINE AND SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-343-4423
Mailing Address - Street 1:102 HIGHLAND AVE SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2256
Mailing Address - Country:US
Mailing Address - Phone:540-343-4423
Mailing Address - Fax:540-343-0495
Practice Address - Street 1:102 HIGHLAND AVE SE
Practice Address - Street 2:SUITE 104
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2256
Practice Address - Country:US
Practice Address - Phone:540-343-4423
Practice Address - Fax:540-343-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040423174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty