Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | LT000875 | PA |
NPI | 1366112005 |
---|---|
Provider Name | Dr. Anthony Di Natale |
First Address | Philadelphia, PA 19104-3820 |
Second Address | Philadelphia, PA 19104-3820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |