Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | MT201497 | PA |
NPI | 1043576424 |
---|---|
Provider Name | Dr. Karla Fitzgerald Leavens |
First Address | Philadelphia, PA 19146-1223 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2012 |
Last Update Date | 29/06/2015 |