Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD 020219-E | PA |
NPI | 1285785634 |
---|---|
Provider Name | Antoine Cawog |
First Address | Greensburg, PA 15601-9550 |
Second Address | Irwin, PA 15642-3440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007501720001 | (05) | PA |
B35482 | (02) | PA |