Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC005916 | PA |
Y | 222Z00000X | Podiatrist | SC005916 | PA |
NPI | 1033159538 |
---|---|
Provider Name | Dr. Matthew T Sabol |
First Address | Altoona, PA 16602-4165 |
Second Address | Altoona, PA 16602-4165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 02/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SC005916 | STATE LICENSURE (01) | PA |