Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | J1-0002360 | DE |
NPI | 1043468390 |
---|---|
Provider Name | Mr. David Scott Logerstedt |
First Address | Newark, DE 19716 |
Second Address | Newark, DE 19716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 28/08/2008 |