Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | OS007188L | PA |
NPI | 1144238825 |
---|---|
Provider Name | Dr. Patrick J Colarusso |
First Address | Reading, PA 19612-3579 |
Second Address | West Reading, PA 19611-1428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 18/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001601293 | (05) | PA |
888602 | MEDICARE PTAN (01) | PA |