Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD420762 | PA |
NPI | 1003866039 |
---|---|
Provider Name | Tyrone D Girdharry |
First Address | Harrisburg, PA 17104-1612 |
Second Address | Lititz, PA 17543-7694 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 02/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019339900001 | (05) | PA |
H79580 | (02) |