Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD467245 | PA |
NPI | 1104059880 |
---|---|
Provider Name | Dr. Roh Yanagida |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-4105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2009 |
Last Update Date | 11/06/2019 |