Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD431397 | PA |
N | 208600000X | Surgeon | MD431397 | PA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD431397 | PA |
NPI | 1306990114 |
---|---|
Provider Name | Joshua Fosnot |
First Address | Philadelphia, PA 19104 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 31/08/2015 |