Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | X010713 | NY |
Y | 213ER0200X | Radiology | X010713 | NY |
NPI | 1821002080 |
---|---|
Provider Name | Dr. Michael Andrew Mestan |
First Address | Seneca Falls, NY 13148-9425 |
Second Address | Seneca Falls, NY 13148-9425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |