Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 25MA05805100 | NJ |
NPI | 1649324955 |
---|---|
Provider Name | Dr. Ghodrat P Sholevar |
First Address | Narberth, PA 19072-1315 |
Second Address | Philadelphia, PA 19133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 05/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1011198830001 | PROMISE NUMBER (01) | PA |