Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | MD057772L | PA |
NPI | 1023046166 |
---|---|
Provider Name | Andrew B Newberg |
First Address | Philadelphia, PA 19107-4216 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 06/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017723070003 | (05) | PA |
0017723070016 | (05) | PA |
9039708 | (05) | NJ |
H01951 | (02) |