Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MT206634 | PA |
N | 207R00000X | Internist | T-2400 | MS |
N | 111NI0900X | Internist | T-2400 | MS |
NPI | 1013204791 |
---|---|
Provider Name | Dr. Lance Christopher Atchley |
First Address | Philadelphia, PA 19104-4238 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 09/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MT206634 | TEMPORARY MEDICAL LICENSE (01) | PA |
T-2400 | MS TEMPORARY TRAIING LICENSE (01) | MS |