Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | NC |
NPI | 1346376423 |
---|---|
Provider Name | Daniel Andrew Bambini |
First Address | Charlotte, NC 27207-1106 |
Second Address | Charlotte, NC 28207-1106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8912806 | (05) | NC |
H42089 | (02) | NC |
N00300 | (05) | SC |