Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD038543L | PA |
NPI | 1073585931 |
---|---|
Provider Name | Mr. Iyalla Ned Adoki |
First Address | Coraopolis, PA 15108-1844 |
Second Address | Coraopolis, PA 15108-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 10/07/2008 |