Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D5020746L | PA |
NPI | 1063462562 |
---|---|
Provider Name | Dr. William Michael Iovino |
First Address | Monroeville, PA 15146-2522 |
Second Address | Monroeville, PA 15146-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T27604 | (02) |