Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD036645-L | PA |
Y | 207QA0505X | Family Doctor - Adult Medicine | MD036645-L | PA |
NPI | 1154433316 |
---|---|
Provider Name | Dr. Joseph Andre Garabedian |
First Address | King Of Prussia, PA 19406-1431 |
Second Address | King Of Prussia, PA 19406-1431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 24/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B33973 | (02) | PA |