Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | OT020577 | PA |
NPI | 1285084871 |
---|---|
Provider Name | Dr. Heather Ann Peluso |
First Address | Philadelphia, PA 19140-4105 |
Second Address | Philadelphia, PA 19140-4105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 07/09/2021 |