Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | MD464365 | PA |
N | 207YP0228X | Pediatric Otolaryngology | MT212920 | PA |
NPI | 1437418050 |
---|---|
Provider Name | Dr. Conor Michael Devine |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 15/01/2019 |