Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD427372 | PA |
NPI | 1023065901 |
---|---|
Provider Name | Bonnie L Serletti |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 11/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1014311400003 | (05) | PA |
F87062 | (02) |