Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 042822L | PA |
Y | 207YS0123X | Facial Plastic Surgeon | 042822L | PA |
NPI | 1740388701 |
---|---|
Provider Name | Dr. Rahul K Naidu |
First Address | Jeannette, PA 15644-2538 |
Second Address | Latrobe, PA 15650-9001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 26/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012456990002 | (05) | PA |
E81241 | (02) |