Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25MA06839900 | NJ |
N | 2080P0204X | Pediatric Emergency Doctor | 25MA06839900 | NJ |
NPI | 1023034147 |
---|---|
Provider Name | Barbara Mcdevitt |
First Address | Livingston, NJ 07039-0717 |
Second Address | Livingston, NJ 07039-4532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 12/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E90954 | (02) | NJ |