Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | C1-0010967 | DE |
N | 207RI0011X | Interventional Cardiology | C1-0010967 | DE |
NPI | 1104080639 |
---|---|
Provider Name | Dr. Antony Leslie Innasimuthu |
First Address | Newark, DE 19713-2133 |
Second Address | Newark, DE 19713-2133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104080639 | (05) | DE |
170266 | (02) | DE |