Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 033220E | PA |
NPI | 1003814807 |
---|---|
Provider Name | Kwabena Adu Ntoso |
First Address | Philadelphia, PA 19106-3500 |
Second Address | Philadelphia, PA 19106-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 11/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000113314605 | (05) | PA |
0000407311 | BLUE CROSS/BLUE SHIELD (01) | |
B41555 | (02) |