Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35047288 | OH |
Y | 111NI0900X | Internist | 35047288 | OH |
NPI | 1003805433 |
---|---|
Provider Name | Patricia E Radigan |
First Address | Lorain, OH 44052-3779 |
Second Address | Lorain, OH 44052-3779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 05/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0711662 | (05) | OH |
110212652 | RR MEDICARE (01) | OH |
A16108 | (02) | OH |