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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
21 CORPORATE DRIVE, SUITE 6, EASTON, PA 18045-2664
(610) 250-9605
(610) 250-3902
Mailing address
21 CORPORATE DRIVE, SUITE 6, EASTON, PA 18045-2664
(610) 250-9605
(610) 250-3902

Taxonomy

Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
MA51321
NJ
207RR0500X
Rheumatology Physician
Primary
MD027186E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001122106
PA
05
2463105
NJ
Enumeration date
06/09/2006
Last updated
02/01/2010
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