Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD047277L | PA |
N | 208200000X | Surgeon | MD047277L | PA |
N | 208600000X | Surgeon | MD047277L | PA |
NPI | 1801835129 |
---|---|
Provider Name | Mysore Anil Kumar |
First Address | Philadelphia, PA 19102-1321 |
Second Address | Philadelphia, PA 19107-1519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 15/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E98142 | (02) | PA |