Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD050854L | PA |
NPI | 1013381011 |
---|---|
Provider Name | Dr. Paul Axelsen |
First Address | Wayne, PA 19087-2014 |
Second Address | Wayne, PA 19087-2014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2015 |
Last Update Date | 15/11/2015 |