Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | MD022508E | PA |
NPI | 1174585418 |
---|---|
Provider Name | Dr. Ethel Marsha Ziselman |
First Address | Malvern, PA 19355 |
Second Address | Malvern, PA 19355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 03/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B36261 | (02) |