Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MA059377 | PA |
NPI | 1003326901 |
---|---|
Provider Name | Alicia Kathleen Crinella |
First Address | Greenfield Township, PA 18407-3737 |
Second Address | Scranton, PA 18510-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2017 |
Last Update Date | 08/10/2020 |