Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 036817-L | PA |
NPI | 1104185610 |
---|---|
Provider Name | Antoine Jahshan |
First Address | Bala Cynwyd, PA 19004-2101 |
Second Address | Bala Cynwyd, PA 19004-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 04/05/2012 |