Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | C1-0012741 | DE |
Y | 208000000X | Pediatrician | C1-0012741 | DE |
NPI | 1760878227 |
---|---|
Provider Name | Jonathan Kussmaul |
First Address | Wilmington, DE 19803-3607 |
Second Address | Wilmington, DE 19803-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2015 |
Last Update Date | 22/01/2019 |