Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD021552E | PA |
NPI | 1093724890 |
---|---|
Provider Name | Dr. Joel Sam Betesh |
First Address | Philadelphia, PA 19148-3347 |
Second Address | Philadelphia, PA 19148-3347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 27/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B40024 | (02) |