Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301081497 | MI |
N | 111NI0900X | Internist | 4301081497 | MI |
Y | 207RN0300X | Nephrologist | 4301081497 | MI |
NPI | 1013099910 |
---|---|
Provider Name | Crystal A. Gadegbeku |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 24/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4520018 | (05) | MI |
G50812 | (02) | MI |