Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD419870 | PA |
N | 111NI0900X | Internist | MD419870 | PA |
Y | 208000000X | Pediatrician | MD-419870 | PA |
NPI | 1003912031 |
---|---|
Provider Name | Dr. Roland Jean Crevecoeur JR. |
First Address | Hollidaysburg, PA 16648-1997 |
Second Address | Hollidaysburg, PA 16648-1997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 20/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001922333 | (05) | PA |
110094 | LEGACY PIN (01) | PA |
G71811 | (02) | PA |
P00432632 | RR PIN (01) | PA |