Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | MA053609 | PA |
NPI | 1053605014 |
---|---|
Provider Name | Alexis A Mayton |
First Address | Phila, PA 19195-0001 |
Second Address | Media, PA 19063-3434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 04/08/2014 |