Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD022095E | PA |
NPI | 1205942273 |
---|---|
Provider Name | Romas Dovydaitis |
First Address | Carbondale, PA 18407-0517 |
Second Address | Clarks Summit, PA 18411-8955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 22/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0692177 | (05) | PA |
B36320 | (02) | PA |