Provider Demographics
NPI:1396873774
Name:TALTY, JANINE MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:JANINE
Middle Name:MARIE
Last Name:TALTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 BRAMBLETON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-4308
Mailing Address - Country:US
Mailing Address - Phone:540-685-2670
Mailing Address - Fax:540-685-2671
Practice Address - Street 1:2702 BRAMBLETON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-4308
Practice Address - Country:US
Practice Address - Phone:540-685-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6830204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102202736OtherMEDICAL LICENSE