Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD007862E | PA |
NPI | 1003088014 |
---|---|
Provider Name | Henry Berkowitz |
First Address | Villanova, PA 19085-1004 |
Second Address | Villanova, PA 19085-1004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 31/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D68591 | (02) | PA |