Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | C1-0008498 | DE |
Y | 207RI0200X | Infectious Disease | MD435097 | PA |
NPI | 1083663694 |
---|---|
Provider Name | Susheer Gandotra |
First Address | East Stroudsburg, PA 18301 |
Second Address | East Stroudsburg, PA 18301-3098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 29/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1021961250001 | (05) | PA |
1083663694 | NPI (01) | DE |