Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | C1-0004626 | DE |
NPI | 1386651099 |
---|---|
Provider Name | Dr. Carl Ramses Yacoub |
First Address | Newark, DE 19713-2146 |
Second Address | Newark, DE 19713-2146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 27/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001164401 | (05) | DE |
G16001 | (02) | DE |