Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 25MA06662000 | NJ |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD063280L | PA |
NPI | 1013944859 |
---|---|
Provider Name | David George Nazarian |
First Address | Philadelphia, PA 19107-4430 |
Second Address | Marlton, NJ 08053-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G56781 | (02) | PA |