Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC007402L | PA |
NPI | 1215149778 |
---|---|
Provider Name | Robert A. Ramirez |
First Address | Mount Laurel, NJ 08054-0305 |
Second Address | Philadelphia, PA 19141-2108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0768798000 | BCBS INDIVIDUAL HMO NO (01) | PA |
3137403 | AETNA HMO PROVIDER NO (01) | PA |
5785730 | AETNA PPO PROVIDER NO (01) | PA |
U74157 | (02) | PA |