Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | MD428894 | PA |
NPI | 1053354696 |
---|---|
Provider Name | Daniel Bolorunduro Fagbuyi |
First Address | Pittsburgh, PA 15213 |
Second Address | Cranberry Township, PA 16066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |