Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC003612 | PA |
N | 111NR0200X | Radiology | DC003612 | PA |
N | 213ER0200X | Radiology | DC003612 | PA |
NPI | 1376543348 |
---|---|
Provider Name | Dr. Andrew Paul Latanishen |
First Address | Ephrata, PA 17522-9450 |
Second Address | Ephrata, PA 17522-9450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105553D5E | RENDERING PROVIDER (01) | PA |
U07295 | (02) | PA |