Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MT224493 | PA |
NPI | 1003486218 |
---|---|
Provider Name | Shahryar Tariq Rana |
First Address | Wilmington, DE 19803-3607 |
Second Address | Wilmington, DE 19810-2139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2021 |
Last Update Date | 29/06/2021 |