Individual
VIDYULLATHA SHIVARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25892 N JAMES MADISON HWY, NEW CANTON, VA 23123-0220
(434) 581-3271
(434) 581-1105
Mailing address
25892 N JAMES MADISON HWY, PO BOX 220, NEW CANTON, VA 23123-0220
(434) 581-3271
(434) 581-1105
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101054431
VA
208000000X
Pediatrics Physician
Primary
0101054431
VA
Other
Enumeration date
07/21/2006
Last updated
11/30/2012
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