Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | MT222267 | PA |
NPI | 1134576051 |
---|---|
Provider Name | Dr. Alisa Timashpolsky |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2016 |
Last Update Date | 23/06/2021 |