Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | OC009229 | PA |
NPI | 1912916057 |
---|---|
Provider Name | Jyoti Raju Naidu |
First Address | Philadelphia, PA 19107-4216 |
Second Address | Devon, PA 19333-1560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 19/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OC009229 | LICENSE (01) | PA |