Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO4063 | FL |
NPI | 1083145650 |
---|---|
Provider Name | Siavash Rostami |
First Address | West Chester, PA 19380-4562 |
Second Address | Drexel Hill, PA 19026-3805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2017 |
Last Update Date | 08/05/2020 |