Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS 003607-L | PA |
Y | 103T00000X | Psychologist | PS 003607-L | PA |
NPI | 1013966803 |
---|---|
Provider Name | Robert William Fleming |
First Address | Mechanicsburg, PA 17050-1611 |
Second Address | Mechanicsburg, PA 17050-1611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 18/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS00360-L | LICENSE NUMBER (01) | PA |