Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | MA07458300 | NJ |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD424645 | PA |
NPI | 1073542718 |
---|---|
Provider Name | Sumon Agarwala |
First Address | Philadelphia, PA 19178-9967 |
Second Address | Collegeville, PA 19426-4927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 15/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12174 | (02) |