Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD455823 | PA |
N | 208000000X | Pediatrician | MT201740 | PA |
NPI | 1003176769 |
---|---|
Provider Name | Dr. Geoffrey Libarnes Bajwa |
First Address | Philadelphia, PA 19123-1527 |
Second Address | Philadelphia, PA 19134-1011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 31/05/2019 |