Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD054347L | PA |
NPI | 1154525582 |
---|---|
Provider Name | Dr. Thiruvalam P Indira |
First Address | Lancaster, PA 17602-4956 |
Second Address | Lancaster, PA 17602-4956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |