Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 214744 | NY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 214744 | NY |
NPI | 1043204662 |
---|---|
Provider Name | Sean Peter Roddy |
First Address | Albany, NY 12208-3797 |
Second Address | Albany, NY 12208-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01991111 | (05) | NY |
G58869 | (02) |