Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD055454L | PA |
N | 208600000X | Surgeon | MD055454L | PA |
Y | 2086X0206X | Surgical Oncologist | MD055454L | PA |
NPI | 1235112293 |
---|---|
Provider Name | Tribhuvan Kumar Pendurthi |
First Address | Bethlehem, PA 18017-8923 |
Second Address | Bethlehem, PA 18017-8923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 15/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14783 | (02) | PA |