Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD029629E | PA |
NPI | 1013990928 |
---|---|
Provider Name | Nestor O. Madrinan |
First Address | Philadelphia, PA 19133-3639 |
Second Address | Philadelphia, PA 19133-3639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01009646-01 | (05) | PA |
E 63959 | (02) |