Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC002264L | PA |
NPI | 1497759336 |
---|---|
Provider Name | Dr. Gary A Cortese |
First Address | Pottsville, PA 17901-3875 |
Second Address | Pottsville, PA 17901-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 20/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012668300003 | (05) | PA |
T72806 | (02) | PA |