Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC003658L | PA |
Y | 222Z00000X | Podiatrist | SC003658L | PA |
N | 213ES0131X | Foot Surgery | SC003658L | PA |
NPI | 1295722874 |
---|---|
Provider Name | Dr. Angelo B Sutera JR. |
First Address | Media, PA 19063-3530 |
Second Address | Media, PA 19063-3530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 17/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1445475 | (05) | PA |
U41693 | (02) | PA |