Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | SC006275 | PA |
N | 213ER0200X | Radiology | SC006275 | PA |
N | 2081S0010X | Sports Medicine | SC006275 | PA |
N | 213ES0000X | Sports Medicine | SC006275 | PA |
Y | 213ES0103X | Foot & Ankle Surgery | SC006275 | PA |
NPI | 1912294851 |
---|---|
Provider Name | Dr. Joseph-Gabriel F Bobadilla |
First Address | Bryn Mawr, PA 19010-3838 |
Second Address | Bryn Mawr, PA 19010-3838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 14/02/2020 |