Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS 029581-L | PA |
NPI | 1114926706 |
---|---|
Provider Name | Robert A Delie |
First Address | Buckingham, PA 18912 |
Second Address | Buckingham, PA 18912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 08/07/2007 |