Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MD455140 | PA |
NPI | 1235429374 |
---|---|
Provider Name | Alicia M Alcamo |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1035002920002 | (05) | PA |