Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 8140 | SC |
NPI | 1255422184 |
---|---|
Provider Name | Dr. Martha Monson Sribnick |
First Address | Fort Jackson, SC 29207-5720 |
Second Address | Fort Jackson, SC 29207-5720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD 000 | (02) | SC |