Individual
WAJIH AKSAMAWATI DIT ARJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
206 CORNELIA ST STE 307, CVPH MEDICAL CENTER - PULMONARY CLINIC, PLATTSBURGH, NY 12901-2779
(518) 562-7705
(518) 562-7706
Mailing address
206 CORNELIA ST STE 307, CVPH MEDICAL CENTER - PULMONARY CLINIC, PLATTSBURGH, NY 12901-2779
(518) 562-7705
(518) 562-7706
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
275140
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
275140
NY
207RP1001X
Pulmonary Disease Physician
Primary
275140
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03921666
—
NY
Enumeration date
08/20/2010
Last updated
03/15/2016
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