Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0011X | Interventional Cardiology | MA059492 | PA |
NPI | 1023520475 |
---|---|
Provider Name | Mr. Michael Robert West |
First Address | Glen Allen, VA 23060-9263 |
Second Address | Springfield, PA 19064-3810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 24/03/2020 |