Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OE0068T | PA |
NPI | 1013029636 |
---|---|
Provider Name | Dr. Deborah Marie Signorino |
First Address | Bryn Mawr, PA 19010-3216 |
Second Address | Bryn Mawr, PA 19010-3216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T30406 | (02) | PA |