Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA10126300 | NJ |
NPI | 1215341490 |
---|---|
Provider Name | Devon Elizabeth Ganter |
First Address | Marlton, NJ 08053-3426 |
Second Address | Marlton, NJ 08053-3446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 18/06/2021 |