Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC003609L | PA |
NPI | 1538173604 |
---|---|
Provider Name | Dr. Kenneth James Dortone |
First Address | Springfield, PA 19064-3009 |
Second Address | Philadelphia, PA 19130-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014109700006 | (05) | PA |
U28126 | (02) | PA |