Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD068633L | PA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD068633L | PA |
NPI | 1134164643 |
---|---|
Provider Name | Alisa Burnham |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 15/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0084620 | (05) | NJ |
101449252 | (05) | PA |
I46260 | (02) |