Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD058860L | PA |
NPI | 1013942564 |
---|---|
Provider Name | Stephen F Wawrose |
First Address | Bethel Park, PA 15102-1841 |
Second Address | Bethel Park, PA 15102-1841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 30/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015913200011 | (05) | PA |
F17314 | (02) |