Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | SC002712-L | PA |
N | 222Z00000X | Podiatrist | SC002712-L | PA |
N | 213EP0504X | Public Medicine | SC002712-L | PA |
N | 111NR0200X | Radiology | SC002712-L | PA |
N | 213ER0200X | Radiology | SC002712-L | PA |
N | 2081S0010X | Sports Medicine | SC002712-L | PA |
N | 213ES0000X | Sports Medicine | SC002712-L | PA |
N | 213ES0103X | Foot & Ankle Surgery | SC002712-L | PA |
Y | 213ES0131X | Foot Surgery | SC002712L | PA |
NPI | 1710988258 |
---|---|
Provider Name | Dr. Josephine T Depalma |
First Address | Philadelphia, PA 19103-5768 |
Second Address | Philadelphia, PA 19128-1745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 12/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010107900006 | (05) | PA |
SC002712L | STATE LICENSE (01) | PA |
T30532 | (02) | PA |