Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD011731E | PA |
NPI | 1144218793 |
---|---|
Provider Name | Dr. Alfred J. Mauriello II |
First Address | Paoli, PA 19301-1608 |
Second Address | Paoli, PA 19301-1608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 26/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006068850001 | (05) | PA |
B37020 | (02) | PA |