Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD043027L | PA |
N | 207YS0123X | Facial Plastic Surgeon | MD043027L | PA |
NPI | 1982767141 |
---|---|
Provider Name | Sean M Smullen |
First Address | Lansdale, PA 19446-1052 |
Second Address | Lansdale, PA 19446-1052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F80047 | (02) |