Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 244272 | NY |
N | 207T00000X | Neurosurgeon | MD438065 | PA |
NPI | 1063603017 |
---|---|
Provider Name | Dr. Eric St. Clair |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 05/10/2016 |