Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD039764E | PA |
NPI | 1487642906 |
---|---|
Provider Name | Dr. Michael A. Picariello |
First Address | Exton, PA 19341-2503 |
Second Address | Exton, PA 19341-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 05/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012509010007 | (05) | PA |
E83728 | (02) | PA |