Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD421168 | PA |
Y | 2081P2900X | Pain Medicine | 231141 | NY |
NPI | 1063405587 |
---|---|
Provider Name | Xiao Fang III |
First Address | Binghamton, NY 13905 |
Second Address | Vestal, NY 13850-1559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 28/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001967228 | (05) | PA |
H85886 | (02) | PA |