Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD042127E | PA |
NPI | 1003830423 |
---|---|
Provider Name | Dr. Robert John Pizziketti |
First Address | York, PA 17402-4668 |
Second Address | York, PA 17402-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 28/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E29929 | (02) | PA |