Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD070762L | PA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD070762L | PA |
NPI | 1346217692 |
---|---|
Provider Name | Dr. Mark Douglas Etter |
First Address | Lancaster, PA 17603-2964 |
Second Address | Lancaster, PA 17603-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 17/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018303300005 | (05) | PA |
H31738 | (02) | PA |