Individual
MARTIN ALPHONSUS NDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
0116036235
VA
390200000X
Student in an Organized Health Care Education/Training Program
LP05464
RI
Other
Enumeration date
08/23/2021
Last updated
06/19/2022
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