Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | OT010641 | PA |
NPI | 1013072305 |
---|---|
Provider Name | Robert Avery |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 20/11/2015 |