Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 213609 | NY |
Y | 204F00000X | Transplant Surgeon | D71017 | MD |
N | 208200000X | Surgeon | 213609 | NY |
N | 208600000X | Surgeon | 213609 | NY |
NPI | 1497721294 |
---|---|
Provider Name | Jonathan Bromberg |
First Address | Baltimore, MD 21264-4226 |
Second Address | Baltimore, MD 21201-1606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 13/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02094439 | (05) | NY |
E69247 | (02) |