Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD460510 | PA |
N | 111NI0900X | Internist | MD460510 | PA |
Y | 207RC0200X | Critical Care Medicine | MD460510 | PA |
N | 207RP1001X | Pulmonary Disease | MD460510 | PA |
NPI | 1013216357 |
---|---|
Provider Name | Dr. Kevin Ma |
First Address | Philadelphia, PA 19104-4238 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2011 |
Last Update Date | 19/09/2019 |