Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD066515L | PA |
NPI | 1326093352 |
---|---|
Provider Name | Dr. Robert J Cabry JR. |
First Address | Havertown, PA 19083-4500 |
Second Address | Havertown, PA 19083-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 11/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038657NU9 | MEDICARE PTAN (01) | PA |
C1808867 | (05) | PA |
H18146 | (02) |