Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | OS018492 | PA |
N | 207R00000X | Internist | OS018492 | PA |
N | 111NI0900X | Internist | OS018492 | PA |
Y | 207RC0200X | Critical Care Medicine | OS018492 | PA |
NPI | 1033556881 |
---|---|
Provider Name | Paul Modelewski |
First Address | Mechanicsburg, PA 17050-8522 |
Second Address | Mechanicsburg, PA 17050-8522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103438507 | (05) | PA |