Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD419298 | PA |
Y | 208600000X | Surgeon | MD419298 | PA |
NPI | 1023038874 |
---|---|
Provider Name | Vladimir Vladimir Iakomi |
First Address | Christiana, PA 17509-9504 |
Second Address | Christiana, PA 17509-9504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I13249 | (02) | PA |