Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD012034E | PA |
NPI | 1588080147 |
---|---|
Provider Name | John Anderson |
First Address | Wyomissing, PA 19610-2216 |
Second Address | Wyomissing, PA 19610-2216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2014 |
Last Update Date | 06/03/2014 |