Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC003864L | PA |
Y | 111NN0400X | Neurology | DC003864L | PA |
NPI | 1629037825 |
---|---|
Provider Name | Dr. Mark D Losagio |
First Address | Bethlehem, PA 18017-3654 |
Second Address | Bethlehem, PA 18017-3654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011539800002 | (05) | PA |