Individual
DR. ITZHAK AVITAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5875 BREMO RD, SUITE 209, RICHMOND, VA 23226-1934
(804) 893-8681
(804) 287-8525
Mailing address
5875 BREMO RD, SUITE 209, RICHMOND, VA 23226-1934
(804) 893-8681
(804) 287-8525
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101251459
VA
2086X0206X
Surgical Oncology Physician
231941
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06695
GROUP PTAN
VA
01
—
C06778
GROUP PTAN
VA
Enumeration date
09/13/2011
Last updated
08/19/2014
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