Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD006592E | PA |
NPI | 1104900125 |
---|---|
Provider Name | Dorothy Czarnecki |
First Address | Philadelphia, PA 19114 |
Second Address | Philadelphia, PA 19114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 04/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01398061 | (05) | PA |
B32852 | (02) |