Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD073620-L | PA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD073620-L | PA |
NPI | 1770564346 |
---|---|
Provider Name | Dr. Wesley Dean Vander Ark |
First Address | Camp Hill, PA 17011-2223 |
Second Address | Camp Hill, PA 17011-2223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 23/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H40718 | (02) | PA |