Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD060887L | PA |
NPI | 1033165360 |
---|---|
Provider Name | Dr. Mehrdad M Soroush |
First Address | Bryn Mawr, PA 19010-1352 |
Second Address | Bryn Mawr, PA 19010-1352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 12/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H13722 | (02) | PA |