Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD465198 | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD465198 | PA |
NPI | 1174937916 |
---|---|
Provider Name | Kyle Ungvarsky |
First Address | Mansfield, PA 16933 |
Second Address | Mansfield, PA 16933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 05/09/2018 |