Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS042965 | PA |
N | 1223G0001X | General Practice | DS042965 | PA |
N | 213EG0000X | General Practice | DS042965 | PA |
NPI | 1003403700 |
---|---|
Provider Name | Dr. Kirubeal Mulugeta |
First Address | Waynesboro, PA 17268-2198 |
Second Address | Waynesboro, PA 17268-2198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2020 |
Last Update Date | 29/12/2020 |