Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC-2055-L | PA |
NPI | 1649225483 |
---|---|
Provider Name | Gerald J. Agasar |
First Address | Newtown, PA 18940-1882 |
Second Address | Newtown, PA 18940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 02/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0780618 | (05) | PA |
T29556 | (02) | PA |