Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD025676E | PA |
NPI | 1285691899 |
---|---|
Provider Name | Dr. Jorge A Otero |
First Address | Bethlehem, PA 18017-4806 |
Second Address | Bethlehem, PA 18017-4806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B40876 | (02) | PA |