Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS026911L | PA |
NPI | 1801877006 |
---|---|
Provider Name | Robert W Queale |
First Address | Greensburg, PA 15601-2503 |
Second Address | Greensburg, PA 15601-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U49826 | (02) | PA |