Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD033626E | PA |
NPI | 1003811704 |
---|---|
Provider Name | Robert Mucciola |
First Address | Johnstown, PA 15905-4305 |
Second Address | Johnstown, PA 15904-3315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E24272 | (02) |