Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 21484 | GA |
NPI | 1134228885 |
---|---|
Provider Name | Dr. Philip William Catalano |
First Address | Augusta, GA 30909-6584 |
Second Address | Augusta, GA 30909-6584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 20/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D39568 | (02) | GA |