Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD022289E | PA |
NPI | 1043228323 |
---|---|
Provider Name | Andrew J Sayre |
First Address | Wellsboro, PA 16901-1840 |
Second Address | Wellsboro, PA 16901-1840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009528010001 | (05) | PA |
80170904 | RAILROAD MEDICARE (01) | |
B34114 | (02) | |
SA40303 | BLUE CROSS/BLUE SH NEPA (01) | PA |