Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 286531 | NY |
Y | 207T00000X | Neurosurgeon | MD465444 | PA |
NPI | 1013451103 |
---|---|
Provider Name | Dr. Georgios Klironomos |
First Address | Williamsport, PA 17701-1900 |
Second Address | Williamsport, PA 17701-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2016 |
Last Update Date | 25/01/2019 |