Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MT187860 | PA |
N | 208600000X | Surgeon | MT187860 | PA |
Y | 2086S0105X | Surgery of the Hand | MD448684 | PA |
NPI | 1912175027 |
---|---|
Provider Name | Dr. Julia Mayberry |
First Address | Wynnewood, PA 19096-3432 |
Second Address | Wynnewood, PA 19096-3432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 06/08/2013 |