Organization
GENERAL THORACIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUSOLA O ODUNTAN MD (OWNER)
(276) 596-6715
Entity
Organization
Contact information
Practice address
3150 CLINCH ST, SUITE 104, RICHLANDS, VA 24641-2159
(276) 596-6715
(276) 596-6717
Mailing address
3150 CLINCH ST, SUITE 104, RICHLANDS, VA 24641-2159
(276) 596-6715
(276) 596-6717
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101240724
VA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
0101240724
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174592125
INDIVIDUAL NPI
VA
Enumeration date
09/19/2008
Last updated
09/19/2008
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