Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD04774L | PA |
NPI | 1063628741 |
---|---|
Provider Name | Dr. Edwin Crews Douglass |
First Address | Melrose Park, PA 19027-3154 |
Second Address | Melrose Park, PA 19027-3154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |