Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD470760 | PA |
Y | 111NI0900X | Internist | MD470760 | PA |
N | 208000000X | Pediatrician | P02079 | NY |
NPI | 1003360645 |
---|---|
Provider Name | Dr. Jesus Manuel Salas Noain |
First Address | Darby, PA 19023-1200 |
Second Address | Darby, PA 19023-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2016 |
Last Update Date | 21/10/2020 |