Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD067614L | PA |
Y | 208600000X | Surgeon | MD067614L | PA |
NPI | 1003817339 |
---|---|
Provider Name | Richard Ing |
First Address | Bryn Mawr, PA 19010-3118 |
Second Address | Bryn Mawr, PA 19010-3118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 21/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F40902 | (02) |