Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD423407 | PA |
NPI | 1063412583 |
---|---|
Provider Name | Dr. Keith Michael Pritchyk |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Scranton, PA 18503-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1011302720001 | (05) | PA |
I04665 | (02) | PA |