Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD 063510L | PA |
NPI | 1053396994 |
---|---|
Provider Name | Sam Stea |
First Address | Montoursville, PA 17754-9314 |
Second Address | Montoursville, PA 17754-9314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F34270 | (02) | PA |