Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG003447 | PA |
NPI | 1013494517 |
---|---|
Provider Name | Allegra M Inciardi |
First Address | Philadelphia, PA 19107-6015 |
Second Address | Havertown, PA 19083-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2018 |
Last Update Date | 14/04/2021 |