Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD029276E | PA |
NPI | 1003812496 |
---|---|
Provider Name | Dr. Edward T Bigos |
First Address | West Lawn, PA 19609-1623 |
Second Address | Wyomissing, PA 19610-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 28/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001129967 | (05) | PA |
B36763 | (02) |