Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | DO476 | AL |
NPI | 1003892084 |
---|---|
Provider Name | Dr. Mary Jane Misischia |
First Address | Birmingham, AL 35205-2881 |
Second Address | Birmingham, AL 35211-1322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G944453 | (02) | TN |