Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC009154 | PA |
NPI | 1073547329 |
---|---|
Provider Name | Thomas P. Canseco |
First Address | Sinking Spring, PA 19608-8620 |
Second Address | Sinking Spring, PA 19608-8620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V03970 | (02) | PA |