Doctor Name: | BOUTROS ZEIDAN |
NPI Number: | 1043204134 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD064590L |
Business Practice Address: | 315 Locust St Suite 5b Johnstown, PA - 159011651 |
Business Phone Number: | 8145352030 |
Business Fax Number: | 8145352031 |
Mailing Address: | 315 Locust St, Suite 5b JOHNSTOWN |
State: | PA |
Postal Code: | 159011651 |
Phone Number: | 8145352030 |
Fax Number: | 8145352031 |
NPI Enumeration Date: | 09/06/2005 |
NPI Last Update Date: | 01/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MD064590L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |