Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC-000653L | PA |
NPI | 1558346403 |
---|---|
Provider Name | Dr. Joann Bevilacqua |
First Address | Carnegie, PA 15106-2048 |
Second Address | Carnegie, PA 15106-2048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00504099 | (05) | PA |
T27500 | (02) | PA |