Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD037356E | PA |
NPI | 1073590345 |
---|---|
Provider Name | Robert Dedio |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 26/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E29423 | (02) | PA |