| Nicholas Raymond Tallman, | |
|
490 S Main St, Rocky Mount, VA 24151-1769 | |
| (540) 484-0350 | |
| Not Available |
| Full Name | Nicholas Raymond Tallman |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 490 S Main St, Rocky Mount, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043742208 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 2020-00777 (North Carolina) | Secondary |
| 208000000X | Pediatrics | 0102208387 (Virginia) | Primary |
| Entity Name | Carilion Healthcare Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1447206370 PECOS PAC ID: 5890607253 Enrollment ID: O20031106000273 |
| Entity Name | Carilion Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1730123472 PECOS PAC ID: 9830096585 Enrollment ID: O20040107000472 |
| Mailing Address | Practice Location Address |
|---|---|
| Nicholas Raymond Tallman, 213 S Jefferson St Ste 1006, Roanoke, VA 24011-1713 Ph: () - | Nicholas Raymond Tallman, 490 S Main St, Rocky Mount, VA 24151-1769 Ph: (540) 484-0350 |
Dr. Vydia Permashwar, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 681 S Main St, Rocky Mount, VA 24151 Phone: 540-483-2849 | |
Dr. Rene Neri Vamenta, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 681 S Main St, Rocky Mount, VA 24151 Phone: 540-483-2849 Fax: 540-483-2826 |