Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 012680000 | MA |
N | 208600000X | Surgeon | 012680000 | MA |
Y | 2086X0206X | Surgical Oncologist | 286381 | NY |
NPI | 1295977155 |
---|---|
Provider Name | Kevin Cerqueira Soares |
First Address | New York, NY 10065-6007 |
Second Address | New York, NY 10065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2009 |
Last Update Date | 28/01/2019 |