Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 15840 | MD |
N | 204E00000X | Oral & Maxillofacial Surgeon | G1-0001385 | DE |
NPI | 1548527104 |
---|---|
Provider Name | Fadi N. Kosa |
First Address | Wilmington, DE 19801-1013 |
Second Address | Wilmington, DE 19801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 20/08/2018 |