Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD069663L | PA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD069663L | PA |
NPI | 1174589477 |
---|---|
Provider Name | Lee Radosh |
First Address | Reading, PA 19612-3579 |
Second Address | West Reading, PA 19611-1410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 06/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01787097 | (05) | PA |