Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD432901 | PA |
NPI | 1477746980 |
---|---|
Provider Name | Pablo Laje |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 14/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102589900-0001 | (05) | PA |