Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MD-027854-E | PA |
NPI | 1194818179 |
---|---|
Provider Name | Dr. Akbar Mostatab |
First Address | King Of Prussia, PA 19406-1137 |
Second Address | King Of Prussia, PA 19406-1137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11442480010 | (05) | PA |
E64162 | (02) | PA |