Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | MD461646 | PA |
NPI | 1235654286 |
---|---|
Provider Name | Dorotea Mutabdzic |
First Address | Philadelphia, PA 19111 |
Second Address | Philadelphia, PA 19111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2017 |
Last Update Date | 11/08/2017 |