Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | A17801 | CA |
Y | 207T00000X | Neurosurgeon | TD-05-102 | ME |
NPI | 1003911405 |
---|---|
Provider Name | Nasrola Edalatpour |
First Address | Newport Beach, CA 92660-5714 |
Second Address | Lewiston, ME 04240-7634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B49877 | (02) | ME |