Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | MD037214 | DC |
NPI | 1467611962 |
---|---|
Provider Name | Jan Casimir Groblewski |
First Address | Providence, RI 02905-2403 |
Second Address | Providence, RI 02905-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 22/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
JG76274 | (05) | RI |