Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD012726E | PA |
NPI | 1003882556 |
---|---|
Provider Name | Frank Theodore Sandsorum JR. |
First Address | Willow Grove, PA 19090 |
Second Address | Willow Grove, PA 19090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B40184 | (02) |