Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD460622 | PA |
NPI | 1003234345 |
---|---|
Provider Name | Peter Puthenveetil |
First Address | Philadelphia, PA 19107-2328 |
Second Address | Langhorne, PA 19047-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 31/01/2018 |