Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MD467035 | PA |
NPI | 1942542360 |
---|---|
Provider Name | Cassandra Formeck |
First Address | Pittsburgh, PA 15224-1334 |
Second Address | Pittsburgh, PA 15224-1334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2013 |
Last Update Date | 24/05/2021 |