Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS016799L | PA |
NPI | 1083678940 |
---|---|
Provider Name | Richard J Plotkin |
First Address | Lafayette Hill, PA 19444-2435 |
Second Address | Bryn Mawr, PA 19010-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 02/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T28650 | (02) | PA |