Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD035499 | DC |
NPI | 1114000148 |
---|---|
Provider Name | Achintya Moulick |
First Address | Philadelphia, PA 19134-1095 |
Second Address | Philadelphia, PA 19134-1095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 11/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H31150 | (02) |