Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD022263E | PA |
Y | 111NI0900X | Internist | MD022263E | PA |
NPI | 1003054099 |
---|---|
Provider Name | Robert Mogul |
First Address | Yardley, PA 19067-6356 |
Second Address | Yardley, PA 19067-6356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 28/01/2009 |