Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD455879 | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD455879 | PA |
Y | 208000000X | Pediatrician | MD455879 | PA |
NPI | 1902144512 |
---|---|
Provider Name | Dr. Daniel Olivero |
First Address | Port Matilda, PA 16870-7725 |
Second Address | Port Matilda, PA 16870-7725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103054821 | (05) | PA |