Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MT188542 | PA |
NPI | 1245445246 |
---|---|
Provider Name | Dr. Krissa Jo George |
First Address | Philadelphia, PA 19152 |
Second Address | Philadelphia, PA 19141-3018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2007 |
Last Update Date | 04/09/2015 |