Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD013036E | PA |
NPI | 1063448751 |
---|---|
Provider Name | Rob Roy Macgregor |
First Address | Philadelphia, PA 19104-6073 |
Second Address | Philadelphia, PA 19104-6073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006628390003 | (05) | PA |
B96831 | (02) |