Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 25MB09350900 | NJ |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036137699 | IL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | OS019448 | PA |
NPI | 1003243361 |
---|---|
Provider Name | Carolyn Botros |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Bethlehem, PA 18017-7334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2013 |
Last Update Date | 17/10/2018 |