Basic Information
| Provider Information | |||||||||
| NPI: | 1174005417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROANOKE VALLEY ENT & ALLERGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8310 | ||||||||
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| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240140310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403453556 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2154 MCVITTY RD | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409687368 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2018 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | LENKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5409687368 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD, PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.