Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | 53618 | GA |
Y | 207YP0228X | Pediatric Otolaryngology | MD418751 | PA |
NPI | 1245269521 |
---|---|
Provider Name | Steven Sobol |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 11/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1025046440001 | (05) | PA |