Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD041515L | PA |
NPI | 1144293473 |
---|---|
Provider Name | Thekkemadom Ramakrishnan |
First Address | Easton, PA 18045-5283 |
Second Address | Easton, PA 18045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 23/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012228270002 | (05) | PA |
01964701 | CAPITAL BLUE CROSS OF PA (01) | |
608831 | HIGHMARK BLUE SHIELD (01) | PA |
E55599 | (02) |