Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD023984E | PA |
N | 111NI0900X | Internist | MD023984E | PA |
Y | 207RN0300X | Nephrologist | MD023984E | PA |
NPI | 1063487783 |
---|---|
Provider Name | Sergio R Vaisman |
First Address | Pottstown, PA 19464-3224 |
Second Address | Pottstown, PA 19464-3224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 13/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B37523 | (02) |