Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD431994 | PA |
N | 2080P0204X | Pediatric Emergency Doctor | MD431994 | PA |
NPI | 1023215217 |
---|---|
Provider Name | Dr. Joanne Smith |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19107-3323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 31/03/2016 |