Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC0002440L | PA |
Y | 222Z00000X | Podiatrist | SC0002440L | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC0002440L | PA |
NPI | 1033211727 |
---|---|
Provider Name | Dr. Gregory S Hatalowich |
First Address | Youngwood, PA 15697-1306 |
Second Address | Youngwood, PA 15697-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 25/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T28642 | (02) | PA |