Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD026074E | PA |
NPI | 1114037975 |
---|---|
Provider Name | P Shripathi Holla |
First Address | Scranton, PA 18510-2369 |
Second Address | Scranton, PA 18510-2369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 07/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C32921 | (02) | |
C32921 | (02) | PA |