Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD055579L | PA |
N | 204F00000X | Transplant Surgeon | ME136930 | FL |
N | 208200000X | Surgeon | MD-055579-L | PA |
N | 208600000X | Surgeon | MD-055579-L | PA |
NPI | 1487614079 |
---|---|
Provider Name | Dr. Cosme Y Manzarbeitia |
First Address | Hershey, PA 17033-2360 |
Second Address | Hershey, PA 17033-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 30/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001524990 | (05) | PA |
100369800 | (05) | FL |
E99871 | (02) |