Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | MD453612 | PA |
NPI | 1669453148 |
---|---|
Provider Name | Dr. Jeffrey Mark Ewig |
First Address | Philadelphia, PA 19107 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 26/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029947970001 | (05) | PA |
E31852 | (02) | FL |